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OF  CALIFORNIA 

LOS  ANGELES 


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COUNSELS  AND   IDEALS 


OXFORD:   HORACE   HART 
PRINTER  TO   THE    UNIVERSITY 


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COUNSELS 

AND  IDEALS 


FROM   THE    WRITINGS    OF 

WILLIAM   OSLER 


BOSTON  AND  NEW  YORK 

HOUGHTON,  MIFFLIN  &  COMPANY 

C{)e  Eiiiersilie  '^vtss,  ((LambxitiQt 

1905 


Biomedicsl 
Library 

w 
'J 

1^0^ 


DEDICATED 

TO 

GRACE   REVERE   OSLER 


695354 


IT  is  now  generally  recognized  that  an  important, 
very  important,  part  of  education,  academic, 
technical,  and  professional,  is  the  personal  influence 
of  the  teacher  upon  the  taught.  Be  the  building, 
the  laboratory,  the  equipment  ever  so  perfect,  there 
yet  must  be  this  essential,  personal  contact  between 
teacher  and  pupil. 

From  personal  association  of  teacher  and  pupil 
follows  that  much  talked  of  and  sought  for  element 
atmosphere.  With  an  atmosphere  an  institution  ■ 
becomes  a  seat  of  learning,  at  which  both  teacher 
and  taught  gain  knowledge,  and  establish  principles 
of  thought  and  conduct,  and  to  which  they  return 
eager  to  breathe  again  its  '  inspiration.' 

Such  is  the  history  of  the  Dutch,  French,  and 
English  Schools,  whose  power  may  be  traced  to 
the  individual  influence  of  the  Masters  of  the 
Italian  School.  Close  upon  these,  indeed  almost 
contemporaneous,  follow  the  German  and  Austrian 
Schools,  and  out  of  all  these  that  composite  pro- 
duct the  American  School.  In  these  Morgagni, 
Valsalva,  Morgan,  Louis,  Rush,  VIrchow,  to  mention 
a  very  few  only,  were  the  '  apostles '  through  whom 
this  '  succession  '  of  influence  passed. 


VUl 

Scientific  institutions  have  been  tardy  in  re- 
cognizing' the  importance  of  this  power  of  influence, 
which  the  artistic  world  has  long  considered  its 
corner-stone.  In  art  or  science,  genius  alone  is 
able  to  flourish  on  the  Geist  from  within. 

For  my  own  purposes,  in  order  to  renew  from 
time  to  time  the  influence  which,  as  pupils  and 
tnternes^  we  had  come  to  depend  upon,  I  have  for 
some  years  made  extracts  from  Dr.  Osier's  Lectures 
and  Addresses  *.  I  would  like  to  share  the  benefits 
of  these  with  others.  At  Oxford,  during  the 
summer  of  1905, '  Counsels  and  Ideals'  under  his 
guidance  took  definite  form. 

Those  who  know  his  personal  influence,  those 

in  and  out  of  our  profession  to  whose  '  unmeaning^ 

taskwork '  in  their  '  brazen  prison '  he  has  shown 

a  way  to 

'escape  .  .  .  and  depart 
On  the  wide  Ocean  of  life  anew,' 

will  welcome  these  pilot  sayings  to  help  grasp  '  the 
rudder  hard '  and  to  see 

How  fair  a  lot  to  fill 
Is  left  to  each  man  still.' 

C.  N.  B.  CAMAa 
New  York  City,  1905. 

*  All  of  Dr.  Osier's  writings,  including  the  seventeen  col- 
lected Addresses  entitled  Aequanimitas,  have  been  consulted. 
Forty-seven  have  been  extracted  for  the  present  volume. 


CONTENTS 


The  selections,  made  almost  exclusively  from  the  less 
technical  Lectures  and  Addresses,  are  grouped  under  the 
following  general  headings : — 

PAGE 

1.  Exemplary  Characters  in  Medicine      .       .  i 

2.  History  AND  Biography ii 

3.  Pioneers  in  Medicine 51 

4.  The  Humanities  in  Medicine  .       .       .       •  57 

5.  The  Practical  in  Medicine       ....  65 

6.  Catholicity  in  Medicine 69 

7.  Honesty,  Truth,  Accuracy,  and  Thorough- 

ness in  Medicine ^^ 

8.  Encouragement  and  Influence  in  Medicine     89 

9.  Silence  and  Self-Control        ....      93 

10.  Patient  Devotion  to  Duty  and  High  Ideals  99 

11.  Charity  and  Fraternity  IN  Medicine    .       .  113 

12.  Medical  Education 127 

13.  Books,  Libraries,  and  Medical  Societies       .  157 

14.  Value  OF  Travel 163 

15.  The  Practitioner  of  Medicine        .       .       -171 

16.  Cupid  and  Marriage 219 

17.  Work 223 

18.  Man's  Years  of  Usefulness,  and  how  he  may 

prolong  them 239 

19.  Religion,  Death,  and  Immortality  .       .       .    247 

20.  Varia 255 

Note. — Each  extract  has  a  numerical  reference  to  the 
original.  By  following  these  numbers  through,  all  the  extracts 
from  one  source  may  be  gathered.  It  is  strongly  urged 
however,  whenever  possible,  to  get  the  original  and  read  it 
throughout. 


REFERENCES 

1.  John  Locke  as  a  Physician. 

Lancet,  1 900. 

2.  The  Importance  of  Post-Graduate  Study. 

Lancet,  1900. 

Aequanimitas  and  Other  Addresses  *. 

3.  Some  Aspects  of  American  Medical  Bibliography. 

Boston  Med,  and  Surg.  Journal,  1902. 
Aequanimitas  and  Other  Addresses  *, 

4.  British  Medicine  in  Greater  Britain. 

Montreal  Med.  Journal,  1897. 
Aequanimitas  and  Other  Addresses  *. 

5.  Medicine  in  the  Nineteenth  Century. 

JVev/  York  Sun,  1901. 
Aequanimitas  and  Other  Addresses  *, 

6.  Internal  Medicine  as  a  Vocation. 

Med.  News  (N.  Y.),  1897. 
Aequanimitas  and  Other  Addresses  ♦. 

7.  William  Beaumont,  a  Pioneer  American  Physiologist. 

Journal  Am.  Med.  Assoc,  1902. 

8.  Rudolph  Virchow :  the  Man  and  the  Student. 

Boston  Med.  and  Surg.  Joumcd,  1891. 

9.  In  Memoriam,  William  Pepper. 

Philad.  Med.  Journal  (N.  Y.),  1899. 

10.  The  Functions  of  a  State  Faculty  (Society). 
Maryland  Med.  Journal,  1897. 

XI.  The  *  Phthisiologia '  of  Richard  Morton. 
Med.  Library  and  Hist.  Journal,  1904. 

*  Blakiston  &  Co.,  Philadelphia,  andT.  K.  Lewis,  London,  1 904. 


XU  REFERENCES 

12.  An  Alabama  Student. 

Johns  Hopkins  Hospital  Bulletin,  1896. 

13.  After  Twenty-five  Years. 

Montreal  Med.  Journal,  1899, 
Aequanimitas  and  Other  Addresses  *. 

14.  Doctor  and  Nurse. 

Johns  Hopkins  Hospital  Bulletin,  1 89 1. 
Aequanimitas  and  Other  Addresses  *. 

15.  Nurse  and  Patient. 

Aequanimitas  and  Other  Addresses  *. 

16.  On  the  Educational  Value  of  the  Medical  Society. 

Aequanimitas  and  Other  Addresses  *. 

17.  The  Practical  Value  of  Laveran's  Discovery. 

Med.  News  (N.  Y.),  1895. 

18.  John  Keats. 

Johns  Hopkins  Hospital  Bulletin,  1896. 

19.  Books  and  Men. 

Boston  Med.  and  Surg.  Journal,  190 1. 
Aequanimitas  and  Other  Addresses  *. 

20.  Aequanimitas. 

Aequanimitas  and  Other  Addresses  *. 

21.  The  Leaven  of  Science. 

i/niv.  (of  Pennsylvania)  Med.  Mag.,  1894. 
Aequanimitas  and  Other  Addresses  *. 

22.  Teacher  and  Student. 

Aequanimitas  and  Other  Addresses  *. 

23.  Chauvinism  in  Medicine. 

Montreal  Med.  Journal,  1902. 
Aequanimitas  and  Other  Addresses  *. 

24.  The  Master  Word  in  Medicine. 

Montreal  Med.  Journal,  1903. 
Aequanimitas  and  Other  Addresses  *. 

25.  Teaching  and  Thinking. 

Montreal  Med.  Journal,  1 895. 
Aequanimitas  and  Other  Addresses  *. 


REFERENCES  xiii 

26.  The  Army  Surgeon. 

Med.  News  (N.  Y.),  1894. 

27.  The  Hospital  as  a  College. 

,    Aequantfnitas  and  Other  Addresses  *. 

JiH^'  Angina  Pectoris  and  Allied  States.    New  York,  1895. 

29.  On  some  of  the  Intestinal  Features  of  Typhoid  Fever. 

Philad.  Med.  Journal^  1898. 

30.  Influence  of  Louis  on  American  Medicine. 

Johns  Hopkins  Hospital  Bulletin,  1897. 

31.  Introductory  Address— Opening  of  Forty-fifth   Session 

of  the  Medical  Faculty,  M<=Gill  University. 
Canada  Med.  and  Surg.  Journal,  1877. 

32.  Science  and  Immortality. 

Houghton,  Mifflin  £r»  Co.,  1 904. 

33.  Richard  Lea  MacDonnell. 

N.  Y.  Med.  Journal,  189 1. 

34.  Thomas  Dover  (of  Dover's  Powder). 

Johns  Hopkins  Hospital  Bulletin,  1 896. 

35.  Alfred  Stilld. 

Univ.  (of  Pennsylvania)  Med.  Bulletin,  1902. 

36.  Remarks  on  William   Pepper  at  the  Mahogany  Tree 

Club,    Philadelphia,    Nov.    15,    1898.     Pamphlet, 
Private  Circulation. 

37.  Remarks  on  occasion  of  the  presentation  to  the  College 

of   Physicians    (Philadelphia)    of   the   Portrait  of 
Dr.  S.  Weir  Mitchell,  April  22,  1890. 
Johns  Hopkins  Hospital  Bulletin,  1890. 

38.  Oliver  Wendell  Holmes. 

Johns  Hopkins  Hospital  Bulletin,  1894. 

39.  The  Problem  of  Typhoid  Fever  in  the  U.  S. 

Med.  News  (N.  Y.),  1899. 

40.  Jean  Martin  Charcot.    Memorial  Notice. 

Johns  Hopkins  Hospital  Bulletin,  1893. 


XIV  REFERENCES 

41.  Unity,  Peace,  and  Concord. 

Farewell  Address  to  the  Medical  Profession  of  the  U.S. 
Journal  Am.  Med.  Assoc,  1905* 

42.  Elisha  Bartlett. 

Trans.  Rhode  Island  Med.  Soc,  1 899. 

43.  Remarks  on  Specialism. 

Boston  Med.  and  Surg.  Journal,  1892. 

44.  Farewell  Address  to  the  Johns  Hopkins  University. 

Journal  Am.  Med.  Assoc,  1 905. 

45.  The  Student  Life. 

Farewell  Address  to  American  and  Canadian  Medical 

Students. 
Med.  News  (N.  Y.),  1905. 

46.  Alcohol. 

St.  Elizabeth  Parish  Magazine  (London),  1 905. 

47.  Ephemerides. 

Montreal  Med.  Journal,  1894. 


EXEMPLARY  CHARACTERS 
IN  MEDICINE 


BIBLIOMANIACS,  CHERISHERS  OF 
BIOGRAPHICAL  RECORDS 

The  men  I  speak  of  (bibliomaniacs)  keep  alive  in  us 
an  interest  in  the  great  men  of  the  past,  and  not  alone 
in  their  works,  which  they  cherish,  but  in  their  lives, 
which  they  emulate.  They  would  remind  us  continually 
that  in  the  records  of  no  other  profession  is  there 
to  be  found  so  large  a  number  of  men  who  have 
combined  intellectual  pre-eminence  with  nobility  of 
character.  '^ 


EXEMPLARY    CHARACTERS 


John  Locke  Among  the  great  men  of  the  seventeenth  century 
(1632-  ^  j^Qj.  Qj^g  Yi2is  more  enduring  claims  to  our  grateful 
character  remembrance  than  John  Locke — philosopher,  phil- 
of;  anthropist,  and  physician.     As  a  philosopher  his 

praise  is  in  the  colleges.  As  the  apostle  of  common 
sense  he  may  be  ranked  with  Socrates  and  a  few 
others  who  have  brought  philosophy  from  the 
clouds  to  the  working-day  world.  Of  his  special 
virtues  and  qualifications  as  the  typical  English 
philosopher  nothing  need  be  said,  but  were  there 
time  I  would  fain  dwell  upon  his  character  as  a 
philanthropist — in  the  truest  sense  of  the  word. 
The  author  of  the  Epistle  on  Toleration^  the 
Treatise  on  Education^  and  the  Constitution  of 
Carolina^  the  man  who  pleaded  for  '  absolute 
Liberty,  just  and  true  Liberty,  equal  and  impartial 
Liberty,'  the  man  who  wrote  the  memorable  words, 
'  All  men  are  naturally  in  a  state  of  freedom,  also 
of  equality,'  must  be  ranked  as  one  of  the  greatest 
benefactors  of  the  race. " 

For  each  one  of  us  there  is  still  '  a  touch  divine ' 
in  the  life  and  writings  of  John  Locke.  A  sin- 
gularly attractive  personality,  with  a  sweet  reason- 
ableness of  temper  and  a  charming  freedom  from 
flaws  and  defects  of  character,  he  is  an  author 
whom,  liking  at  the  first  acquaintance,  we  soon 
love  as  a  friend.  Perhaps  the  greatest,  certainly, 
as  Professor  Fowler  says,  the  most  characteristic 
English  philosopher,  we  may  claim  Dr.  Locke  as 
a  bright  ornament  of  our  profession,  not  so  much 
for  what  he  did  in  it,  as  for  the  methods  which  he 


his  in- 
fluence. 


IN    MEDICINE  3 

inculcated,  and  the  influence  which  he  exercised 
upon  the  English  Hippocrates.  He  has  a  higher 
claim  as  a  really  great  benefactor  of  humanity, 
one  of  the  few  who,  as  was  so  finely  said  of 
Isocrates,  '  reflected  the  human  spirit  always  on  the 
nobler  side.'  One  of  Locke's  earliest  writings  was 
a  translation  for  Lady  Shaftesbury  of  Pierre  Nicole's 
Essays^  in  one  of  which,  on  the  'Way  of  Preserving 
Peace  with  Men,'  Locke  seems  to  have  found  a  rule 
of  life  which  I  commend  to  you :  '  Live  the  best 
life  you  can,  but  live  it  so  as  not  to  give  needless 
offence  to  others ;  do  all  you  can  to  avoid  the  vices, 
follies,  and  weaknesses  of  your  neighbours,  but 
take  no  needless  offence  at  their  divergences  from 
your  ideal.' ' 

You  have  been  fortunate  in  having  associated  with  Jonathan 
your  college  (Medical  Graduate  College  and  Poly-  Hutchinson. 
cHnic,  England)  a  man  with  a  truly  Hunterian  mind. 
In  the  broad  scope  of  his  work,  in  the  untiring  zeal 
with  which  he  has  studied  the  natural  phenomena 
of  disease,  in  his  love  for  specimens  and  collections, 
Mr.  Jonathan  Hutchinson  bears  a  strong  likeness  to 
the  immortal  Hunter.  No  individual  contributor  in 
this  country  has  made  so  many  careful  observations 
upon  so  many  diseases.  He  is  the  only  great 
generalized  specialist  which  the  profession  has 
produced,  and  his  works  are  a  storehouse  upon 
which  the  surgeon,  the  physician,  the  neurologist, 
the  dermatologist,  and  other  specialists  freely  draw. 
When  anything  turns  up  which  is  anomalous  or 
peculiar,  anything  upon  which  the  textbooks  are 
B  2 


EXEMPLARY    CHARACTERS 


Sydenham 
(1624-89)  : 

scepticism 
in  Medicine. 

Linacre 
(1460- 

1524)- 


The  man 
and  his 
oppor- 
tunity. 


silent  and  the  systems  and  cyclopaedias  are  dumb, 
I  tell  my  students  to  turn  to  the  volumes  of 
Mr.  Hutchinson's  Archives  of  Surgery^  as  if  it  is 
not  mentioned  in  them,  it  surely  is  something  very 
much  out  of  the  common.  It  is  very  fortunate  that 
his  collection  will  be  kept  together,  as  it  will  be  of 
great  service  to  students  from  all  parts  of  the  world. 
In  one  respect  it  is  unique,  pictorial  and  clinical, 
not  anatomical  and  pathological,  and  it  will  remain 
a  worthy  monument  to  the  zeal  and  perseverance 
of  a  remarkable  man,  a  man  who  has  secured  the 
homage  of  a  larger  number  of  clinical  workers  than 
any  Englishman  of  his  generation.  ^ 

Sydenham  was  called  '  a  man  of  many  doubts,'  and 
therein  lay  the  secret  of  his  great  strength.  ^ 

Linacre,  as  Dr.  Payne  remarks,  '  was  possessed 
from  his  youth  till  his  death  by  the  enthusiasm  of 
learning.  He  was  an  idealist  devoted  to  objects 
which  the  world  thought  of  little  use.'  Painstaking, 
accurate,  critical,  hypercritical  perhaps,  he  remains 
to-day  the  chief  literary  representative  of  British 
Medicine.  Neither  in  Britain  nor  in  greater  Britain 
have  we  maintained  the  place  in  the  world  of  letters 
created  for  us  by  Linacre 's  noble  start.  * 

Come  with  me  for  a  few  minutes  on  a  lovely  June 
day  in  1822,  to  what  was  then  far-off  northern 
wilds,  to  the  island  of  Michilimackinac,  where  the 
waters  of  Lake  Michigan  and  Lake  Huron  unite. 


IN    MEDICINE  5 

and  where  stands  Fort  Mackinac,  rich  in  the 
memories  of  Indian  and  voyageur^  one  of  the  four 
important  posts  on  the  upper  lakes  in  the  days 
when  the  rose  and  the  fleur-de-lys  strove  for  the 
mastery  of  the  western  world.  Here  the  noble 
Marquette  laboured  for  his  Lord,  and  here  beneath 
the  chapel  of  St.  Ignace  they  laid  his  bones  to  rest. 
Here  the  intrepid  La  Salle,  the  brave  Tonty,  and 
the  resolute  Du  Luht  had  halted  in  their  wild 
wanderings.  Its  palisades  and  block -houses  had 
echoed  the  war-whoops  of  Ojibwas  and  Ottawas,  of 
Hurons  and  Iroquois,  and  the  old  fort  had  been 
the  scene  of  bloody  massacres  and  hard-fought 
fights,  but  at  the  conclusion  of  the  War  of  1812, 
after  two  centuries  of  struggle,  peace  settled  at  last 
on  the  island.  The  fort  was  occupied  by  United 
States  troops,  who  kept  the  Indians  in  check  and 
did  general  police  duty  on  the  frontier,  and  the 
place  had  become  a  rendezvous  for  Indians  and 
voyageurs  in  the  employ  of  the  American  Fur 
Company.  On  this  bright  spring  morning  the 
village  presented  an  animated  scene.  The  annual 
return  tide  to  the  trading-post  was  in  full  course, 
and  the  beach  was  thronged  with  canoes  and 
batteaux  laden  with  the  pelts  of  the  winter's  hunt. 
Voyageurs  and  Indians,  men,  women,  and  children, 
with  here  and  there  a  few  soldiers,  made  up  a 
motley  crowd.  Suddenly  from  the  company's 
store  there  is  a  loud  report  of  a  gun,  and  amid  the 
confusion  and  excitement  the  rumour  spreads  of 
an  accident,  and  there  is  a  hurrying  of  messengers 
to  the  barracks  for  a  doctor.     In  a  few  minutes 


6  EXEMPLARY    CHARACTERS 

(Beaumont  says  twenty-five  or  thirty,  an  eye- 
witness says  three)  an  alert-looking  man  in  the 
uniform  of  a  U.  S.  army  surgeon  made  his  way 
through  the  crowd  and  was  at  the  side  of  a  young 
French-Canadian  who  had  been  wounded  by  the 
discharge  of  a  gun,  and  with  a  composure  bred  of 
an  exceptional  experience  of  such  injuries,  prepared 
to  make  the  examination.  Though  youthful  in 
appearance.  Surgeon  Beaumont  had  seen  much 
service,  and  at  the  capture  of  York  and  at  the 
investment  of  Plattsburgh  had  shown  a  coolness 
and  bravery  under  fire  which  had  won  him  high 
praise  from  his  superior  officers.  The  man  and 
the  opportunity  had  met — the  outcome  is  my  story 
of  this  evening. ' 


Visit  to         In  1 884,  on  returning  to  Berlin  for  the  first  time 

Virchow        since  my  student  days,  I  took  with  me  four  choice 
(1821-1902} : 

examples  of  skulls  of  British  Colimibian  Indians, 

knowing  well  how  acceptable  they  would  be.     In 

his  room  at  the  Pathological  Institute,  surrounded 

by  crania  and  skeletons,  and  directing  his  celebrated 

'  Diener,'  who  was  mending  Trojan  pottery,  I  found 

the  professor  noting  the  peculiarities  of  a  set  of 

bones  which  he  had  just  received  from  Madeira. 

Not  the  warm  thanks,  nor  the  cheerful,  friendly 

greeting  which  he  always  had  for  an  old  student, 

pleased  me  half  as  much  as  the  prompt  and  decisive 

identification  of  the  skulls  which  I  had  brought, 

and  his  rapid  sketch  of  the  cranial  characters  of 

the  North  American  Indian.   The  profound  expert. 


IN    MEDICINE  7 

not  the  dilettante  student,  has  characterized  all  of 
his  work  in  this  line.  ^ 

It  will  be  acknowledged  that  in  this  country  doctors  the  citizen, 
are,  as  a  rule,  bad  citizens,  taking  little  or  no 
interest  in  civic,  state,  or  national  politics.  Let  me 
detain  you  a  moment  or  two  longer  to  tell  of  one  of 
us,  at  least,  who,  in  the  midst  of  absorbing  pursuits, 
has  found  time  to  serve  his  city  and  his  country. 
For  more  than  twenty  years  Virchow  has  sat  in  the 
Berlin  City  Council  as  an  alderman,  and  to  no 
feature  in  his  extraordinary  life  does  the  Berliner 
point  with  more  justifiable  pride.  It  is  a  combina- 
tion of  qualities  only  too  rare,  when  the  learned 
professor  can  leave  his  laboratory  and  take  his  share 
in  the  practical  municipal  work.  How  much  his 
colleagues  have  appreciated  his  efforts  has  been 
shown  by  his  election  as  Vice-president  of  the 
Board;  and  on  the  occasion  of  the  celebration 
in  1 88 1,  the  Rathaus  was  not  only  placed  at  the 
disposal  of  the  committee,  but  the  expenses  of 
the  decorations,  &c.,  were  met  by  the  council ;  and 
to-day  comes  word  by  cable  that  he  has  been 
presented  with  the  freedom  of  the  city.  ^ 

In   that  noble  poem  Rugby  Chapel^  in  memory  William 
of  his  father,   Matthew  Arnold  draws  a  strong  ^|^^!*^8)' 
contrast,   on   the  one  hand,  between  the  average  a  strong 
man,  who  eddies  about,  eats  and  drinks,  chatters  ^°"^ » 
and  loves  and  hates,  and  then  dies,  having  striven 
blindly  and  achieved  nothing ;  and,  on  the  other, 
the  strong  soul  tempered  with  fire,  not  Uke  the 


8 


EXEMPLARY   CHARACTERS 


a  leader 


a  child  of 
fortune ; 


men  of  the  crowd,  but  fervent,  heroic,  and  good, 
the  helper  and  friend  of  mankind.  Dr.  William 
Pepper,  whose  loss  we  mourn  to-day,  while  not 
a  Thomas  Arnold,  belonged  to  this  group  of  strong 
souls,  our  leaders  and  masters,  the  men  who  make 
progress  possible. 

There  are  two  great  types  of  leaders :  one,  the 
great  reformer,  the  dreamer  of  dreams  with  aspira- 
tions completely  in  the  van  of  his  generation,  lives 
often  in  wrath  and  disputations,  passes  through 
fiery  ordeals,  is  misunderstood,  and  too  often 
despised  and  rejected  by  his  generation.  The 
other,  a  very  different  type,  is  the  leader  who  sees 
ahead  of  his  generation,  but  who  has  the  sense  to 
walk  and  work  in  it.  While  not  such  a  potent 
element  in  progress,  he  lives  a  happier  life,  and 
is  more  likely  to  see  the  fulfilment  of  his  plans. 
Of  this  latter  type  the  late  Professor  of  Medicine 
at  the  University  of  Pennsylvania  was  a  notable 
example — the  most  notable  the  profession  of  this 
country  has  offered  to  the  world.  ^ 

William  Pepper  began  life  under  conditions  which 
are  very  often  unfavourable  to  success.  His  father, 
a  distinguished  physician,  the  Professor  of  Medicine 
in  the  school  in  which  his  son  was  educated,  be- 
longed to  a  family  of  position  and  influence.  For 
the  young  man  there  were  none  of  those  tempering 
'blows  of  circumstance,'  no  evil  star  with  which 
to  grapple  and  grow  strong.  Quite  as  much  '  grit ' 
and  a  much  harder  climb  are  needed  to  reach 
distinction  from  the  top  as  from  the  bottom  of 


IN    MEDICINE  9 

the  social  scale,  and  to  rise  superior  to  the  res 
abundaiis  domi  has  taxed  to  the  uttermost  many 
young  men  in  this  country.  We  have  heard  enough 
of  the  self-made  men,  who  are  always  on  top ;  it 
is  time  now  to  encourage  in  America  the  young 
fellow  who  is  unhappily  born  '  with  a  silver  spoon 
in  his  mouth.'  Like  the  young  man  in  the  Gospels, 
he  is  too  apt  to  turn  away  sorrowfully  from  the  batde 
of  life,  and  to  fritter  away  his  energies  in  Europe, 
or  to  go  to  the  devil  in  a  very  ungendemanly 
manner,  or  to  become  the  victim  of  neurasthenia. 
To  such  the  career  I  am  about  to  sketch  should 
prove  a  stimulus  and  an  encouragement.  ^ 

In  many  ways  the  American  is  the  modem  Greek,  a  modern 
particularly  in  that  power  of  thinking  and  acting,  ^®®  " 
which  was  the  strongest  Hellenic  characteristic. 
Born  and  bred  in  one  of  the  most  conservative 
of  cities,  surrounded  by  men  who  loved  the  old 
order,  and  who  hated  change  or  even  the  suggestion 
of  it,  Pepper  displayed  from  the  outset  an  adapti- 
bility  and  flexibility  truly  Grecian.  He  was  pre- 
eminently a  man  of  felicities  and  facilities,  to  use 
a  somewhat  flash  but  suitable  phrase.  Matthew 
Arnold's  comment  upon  the  happy  and  gracious 
flexibility  which  was  so  incarnate  in  Pericles  has 
often  occurred  to  me  in  thinking  of  the  character 
of  the  late  Provost :  '  lucidity  of  thought,  clearness 
and  propriety  of  language,  freedom  from  prejudice, 
freedom  from  stiffness,  openness  of  mind,  and  amia- 
bility of  manner.'  There  was  another  Grecian 
feature  which  must  not  be  lost  sight  of.     You 


lO     EXEMPLARY  CHARACTERS  IN   MEDICINE 

remember  in  the  Timaeus  how  the  Egyptian  priest 
said  to  Solon :  '  You  Hellenes  are  never  anything 
but  children ;  there  is  not  an  old  man  among  you 
...  in  mind  you  are  all  young.' 

To  the  very  last  there  was  a  youthful  hopefulness 
and  buoyancy  of  spirits  about  Pepper  that  supported 
him  in  many  trials  and  troubles.  I  never  knew 
him  despondent  or  despairing-.  The  persistency 
of  this  buoyant  hopefulness  often  wore  out  the  most 
obstinate  opposition ;  in  fact,  it  was  irresistible. 
Nor  was  it  the  hopefulness  which  we  condemn 
as  visionary,  but  a  resourceful  hopefulness,  based 
on  confidence  in  himself,  and,  most  valuable  quality 
of  all,  capable  of  inspiring  confidence  in  others.  ^ 


HISTORY  AND  BIOGRAPHY 


VALUE  OF  BIOGRAPHICAL  STUDY 

Of  the  altnilstic  instincts  veneration  is  not  the  most 
highly  developed  at  the  present  day ;  but  I  hold  strongly 
with  the  statement  that  it  is  the  sign  of  a  dry  age  when 
the  great  men  of  the  past  are  held  in  light  esteem. " 

THE  HISTORICAL  METHOD 

By  the  historical  method  alone  can  many  problems  in 
medicine  be  approached  profitably.  For  example,  the 
student  who  dates  his  knowledge  of  tuberculosis  from 
Koch  may  have  a  very  correct,  but  a  very  incomplete, 
appreciation  of  the  subject.  Within  a  quarter  of  a  century 
our  libraries  will  have  certain  alcoves  devoted  to  the 
historical  consideration  of  the  g^eat  diseases,  which  will 
give  to  the  student  that  mental  perspective  which  is  so 
valuable  an  equipment  in  life.  The  past  is  a  good  nurse, 
as  Lowell  remarks,  particularly  for  the  weanlings  of  the 
fold.  '9 


12  HISTORY   AND 

Value  of  Editions  of  the  Hippocratic  writings  appear  from 
studv^^*^  time  to  time,  and  in  the  revival  of  the  study  of  the 
history  of  medicine  the  writings  of  such  masters  as 
Galen  and  Aretaeus  reappear,  but  the  interest  is 
scholastic,  and  amid  the  multiplicity  of  studies  how 
can  we  ask  the  student  to  make  himself  familiar 
with  the  ancients?  We  can,  however,  approach 
the  consideration  of  most  subjects  from  an  historical 
standpoint,  and  the  young  doctor  who  thinks  that 
pathology  began  with  Virchow  gets  about  the  same 
erroneous  notion  as  the  student  who  begins  the 
study  of  American  history  with  the  Declaration 
of  Independence.  ^ 


*  In  the  present  crowded  state  of  the  curriculum  it 
does  not  seem  desirable  to  add  the  "  History  of 
Medicine  "  as  a  compulsory  subject.  An  attractive 
course  will  catch  the  good  men  and  do  them  good, 
but  much  more  valuable  is  it  to  train  the  mind  of 
the  student  to  look  at  things  from  the  historical 
standpoint,  and  this  can  be  done  by  individual 
teachers  who  themselves  appreciate  the  truth  of 
Fuller's  remark,  "  History  maketh  a  young  man 
to  be  old  without  either  wrinkles  or  grey  hairs ; 
privileging  him  with  the  experience  of  age  without 
either  the  infirmities  or  inconveniences  thereof. 
Yea,  it  not  only  maketh  things  past  present,  but 
enableth  one  to  make  a  rational  conjecture  of  things 
to  come.  For  this  world  affordeth  no  new  accidents, 
but  in  the  same  sense  wherein  we  call  it  a  new 
moon^  which  is  the  old  one  in  another  shape  ;  and 
yet  no  other  than  that  hath  been  formerly.  Old 
actions  return  again,  furbished  over  with  some  new 
and  different  circumstances.'" — {B.  M.J.^  1902.) 


BIOGRAPHY  13 

For  countless  generations  the  prophets  and  kings  Science, 
of  humanity  have  desired  to  see  the  things  which  Jj^lef^"*^ 
men  have  seen,  and  to  hear  the  things  which  men  blessing, 
have  heard,  in  the  course  of  this  wonderful  nine- 
teenth century.  To  the  call  of  the  watchers  on 
the  towers  of  progress  there  has  been  the  one  sad 
answer — the  people  sit  in  darkness  and  in  the 
shadow  of  death.  Politically,  socially,  and  morally 
the  race  has  improved,  but  for  the  unit,  for  the 
individual,  there  was  little  hope.  Cold  philosophy 
shed  a  glimmer  of  light  on  his  path,  religion  in  its 
various  guises  illumined  his  sad  heart,  but  neither 
availed  to  lift  the  curse  of  suffering  from  the  sin- 
begotten  son  of  Adam.  In  the  fullness  of  time, 
long  expected,  long  delayed,  at  last  science 
emptied  upon  him  from  the  horn  of  Amalthea 
blessings  which  cannot  be  enumerated,  blessings 
which  have  made  the  century  for  ever  memorable  ; 
and  which  have  followed  each  other  with  a  rapidity 
so  bewildering  that  we  know  not  what  next  to 
expect.  ^ 

To  us  In  the  medical  profession,  who   deal  with  The  gift  of 
this   unit  (the  individual),  and   measure   progress  teen^tlTcen- 
by  the  law  of  the  greatest  happiness  to  the  greatest  tury  to 
number,  to  us  whose  work  is  with  the  sick  and  "i^'^^i"*^- 
suffering,  the  great  boon  of  this  wonderful  century, 
with   which   no   other   can   be   compared,   is   the 
fact  that  the  leaves  of  the  tree  of  science  have  been 
for  the  healing  of  the  nations.     Measure  as  we  may 
the  progress  of  the  world — materially,  in  the  ad- 
vantages of  steam,  electricity,  and  other  mechanical 


14 


HISTORY    AND 


appliances ;  sociologically,  in  the  great  improve- 
ment in  the  conditions  of  life ;  intellectually,  in 
the  diffusion  of  education ;  morally,  in  a  possibly 
higher  standard  of  ethics — there  is  no  one  measure 
which  can  compare  with  the  decrease  of  physical 
suffering  in  man,  woman,  and  child,  when  stricken 
by  disease  or  accident.  This  is  the  one  fact  of 
supreme  personal  import  to  every  one  of  us.  This 
is  the  Promethean  gift  of  the  century  to  man.  ^ 

The  vice  of  The  fetters  of  a  thousand  years  in  the  treatment  of 
authority,  fever  were  shattered  by  Sydenham,  shattered  only 
to  be  riveted  anew.  How  hard  was  the  battle  in 
this  century  against  the  entrenched  and  stubborn 
foe !  Listen  to  the  eloquent  pleadings  of  Stokes, 
pleading  as  did  Sydenham,  against  authority  and 
against  the  bleedings,  the  purgings,  and  sweatings 
of  fifty  years  ago.  '  Though  the  hair  be  grey  and 
his  authority  high,  he  is  but  a  child  in  knowledge 
and  his  reputation  an  error.  On  a  level  with  a 
child  so  far  as  correct  appreciation  of  the  great 
truths  of  medicine  is  concerned,  he  is  very  different 
in  other  respects,  his  powers  of  doing  mischief  are 
greater ;  he^  is  far  more  dangerous.  Oh  that 
men  would  stoop  to  learn,  or  at  least  cease  to 
destroy ! '  * 

Not  in  vain  has  he  wandered  amid  green  pastures, 
and  by  the  still  waters  in  the  Garden  of  the  Gods, 
and  the  Pierian  roses  which  he  has  gathered  have 
the  bloom  and  much  of  the  fragrance  of  those  which 
deck  the  brows  of  our  brother-craftsmen — of  Gold- 


Weir 
Mitchell 


BIOGRAPHY  15 

smith,  of  Keats,  and  of  Holmes.  Heredity  has  done 
much,  environment  has  done  more,  in  the  career  of 
which  I  speak.  Unlike  the  majority  of  those  who 
have  '  passed  the  chair  '  of  this  honourable  Faculty, 
the  path  along  which  Weir  Mitchell  trod  to  fame 
led  around,  not  through,  Academic  Halls.  When 
University  positions  are  so  coveted,  and  when  the 
ambition  of  every  worker  is  to  teach,  it  is  a  satis- 
faction to  be  able  to  point  to  a  man  who  has  risen 
from  the  ranks,  so  to  speak,  to  the  highest  general- 
ship and  command.  But  may  I  allude — if  only  to 
show  the  truth  of  Schiller's  dictum, 

'Des  Lebens  ungemischte  Freude 
Ward  keinem  Irdischen  zum  Theil' — 

to  disappointed  academic  ambitions  on  the  part  of 
our  distinguished  fellow,  now  long  past,  perhaps 
even  forgotten  by  him?  Truly  the  stone  which 
the  builders  rejected  has  become  the  chief  stone 
of  the  corner.  For  his  sake  I  have  always  thought 
that  in  so  doing  they  'builded  better  than  they 
knew.' 

Again;  in  relation  to  this  college  (College  of 
Physicians),  around  which  clusters  so  large  a  part 
of  all  that  is  best  in  the  history  of  the  profession  of 
this  city  (Philadelphia),  the  man  whom  we  delight 
to  honour  has  fostered  its  growth,  widened  its 
influence,  and  stimulated  its  life.  For  this  we 
thank  him  best  when  we  place  his  portrait  in  line 
with  those  of  Redman,  Shippen,  and  Wood. 

It  is  too  weird  a  speculation  to  think  that  here 
to-night  in  this  hall  amid  the  volumes  of  forgotten 


t6 


HISTORY    AND 


lore,  a  ghostly  procession  of  our  presidents  who 
have  gone  will  pass  verdict  on  this  picture  and  will 
greet  as  worthy  one  who,  caute^  caste  et  probCy 
supported  the  traditions  which  they  held  so  dear. 
Amid  the  racket  and  hurly-burly  few  of  us  have  the 
chance  to  warm  both  hands  at  the  fire  of  life.  No 
member  of  the  profession  in  his  generation,  either  in 
America  or  Europe,  has  so  pleasantly  toasted  hands 
and  feet  before  the  logs  as  S.  Weir  Mitchell ;  and  no 
one  has  been  more  ready  to  give  a  brother  a  place 
at  the  glowing  hearth.  If  asked  for  a  scroll  to  place 
beneath  that  frame  I  would  write  that  he  was  one 

'  Whose  even  balanced  soul 
Business  could  not  make  dull,  nor  passion  wild  ; 
Who  saw  life  steadily  and  saw  it  whole.' ^^ 


Charcot 
(1825-93) : 


cosmopoli- 
tan; 


Now  and  again  there  is  given  to  medicine  a  man 
whose  life  and  work  make  an  enduring  impression, 
and  who,  escaping  the  thralls  of  nationalism,  becomes 
a  cosmopolitan  teacher  and  leader.  The  latter  part 
of  this  century  has  had  only  three  or  four  such 
men:  Lister  in  Great  Britain,  Virchow  and  Koch 
in  Germany,  Pasteur  in  France — men  who  have 
revolutionized  medicine  by  brilliant  discoveries  and 
by  the  introduction  of  new  methods,  and  who  have 
moulded  anew  our  works  and  ways,  and  have 
widened  the  horizon  of  our  thoughts.  In  this  select 
circle  by  virtue  of  extraordinary  labours,  the  suffrages 
of  our  Guild,  the  world  over,  had  placed  Jean  Martin 
Charcot,  whose  sudden  death  on  August  the  i6th 
last  has  been  so  universally  deplored.  ^ 


BIOGRAPHY  17 

A  feature  which  helped  not  a  little  in  Charcot's  attractive 
success  was  a  personality  attractive  to  young  men.  ^if^°" 
.  .  .  Charcot's  method  of  teaching  was  in  striking 
contrast  to  that  of  his  colleagues  at  other  French 
hospitals.  .  .  .  Half  an  hour  before  the  lecture  the 
front  rows  were  filled  with  enthusiastic  students, 
and  by  the  time  the  lecture  began  there  was  standing- 
room  only.   Without  any  attempt  at  display  or  effect,  a  teacher 
interesting  cases  were  brought  in,  the  symptoms  ^,^*'^°"^    . 
analysed,  the  diagnosis  made,  the  anatomical  condi-  display  or 
tion  discussed,  usually  with  the  aid  of  black-board  and  effect ; 
chalks,  followed,  in  conclusion,by  a  few  general  com- 
ments.    It  was  a  clinical  lecture  in  the  true  sense  of  a  clinical 
the  term.     Without  volubility,  Charcot  possessed  lecture, 
in  a  marked  degree  that  charming  lucidity  in  the  ^^fj^otit'^ 
presentation  of  a  subject  so  characteristic  of  his  volubility, 
countrymen.  ^° 

A  finely  tempered  individualism,  prone  though  it  France 

be  to  excess,  is  one  of  the  glories  of  the  French  honours  her 

great  men. 
character.     The  man  in  France  stands  for  more 

than  in  any  other  land ;  his  worth  and  work  are 

there  more  truly  recognized,  and  there  his  relative 

position  in  the  history  of  art,  literature,  or  science 

is  more  justly  gauged.     Alone  among  the  nations 

of  the  world,  France  honours  duly  the  mighty  dead 

of  our  profession.    Not  in  the  Pantheon  only,  but  in 

statues,  in  the  names  of  streets,  and  in  the  names  of 

hospitals  one  is  constantly  reminded  in  Paris  that 

such  men  as   Bichat,  Laennec,  Pinel,  Trousseau, 

Broca,  Bernard,  and  others  have  honourably  served 

their  day  and  generation.  '^ 

C 


i8 


HISTORY   AND 


William 
Pepper 
(1843-98) : 


a  cultured 
Hellene  ; 


The  medical  profession  in  every  country  has  pro- 
duced men  of  affairs  of  the  first  rank,  men  who 
have  risen  high  in  the  councils  of  nations,  but  with 
scarcely  any  exception  the  practice  of  medicine  has 
not  been  compatible  with  such  duties.  So  absorb- 
ing are  the  cares  of  the  general  practitioner  or  the 
successful  consultant  that  he  has  but  little  time  to 
mingle  in  outside  affairs,  and  the  few  who  enter 
public  life  do  so  with  many  backward  glances  at 
the  consulting-room,  and  with  well-grounded  fore- 
bodings of  disaster  to  professional  work.  But  Dr. 
Pepper  maintained  to  the  end  the  closest  relations 
with  the  profession,  both  as  a  consultant  and  a 
teacher.  To  me  one  of  the  most  remarkable 
features  of  his  life  is  the  conscientiousness  with 
which  he  attended  to  a  large  and  exacting  practice. 
That  amid  such  multifarious  cares  and  duties  he 
should  have  been  able  to  maintain  an  undiminished 
activity  in  his  calling  is  perhaps  the  greatest  tribute 
to  his  genius.  As  a  teacher  his  forte  was  in  the 
amphitheatre,  where  he  displayed  precision  in 
diagnosis,  great  lucidity  in  the  presentation  of 
a  complicated  case,  and  a  judicious  and  thorough 
knowledge  of  the  resources  of  art.  ^ 

The  tribute  of  words  has  already  been  paid,  but  to 
us,  of  his  circle,  two  aspects  of  his  character  may  be 
dwelt  upon  for  a  moment.  William  Pepper  was 
the  embodiment  of  that  happy  and  gracious  flexi- 
bility which  distinguished  the  best  of  the  old  Greeks. 
Matthew  Arnold's  portrayal  of  the  cultured  Hellene 
can  be  transferred  to  him  with  singular  appropriate- 


BIOGRAPHY  19 

ness :  '  Lucidity  of  thought,  clearness  and  propriety 
of  language,  freedom  from  prejudice,  freedom  from 
stiffness,  openness  of  mind,  and  amiability  of  man- 
ner.' The  greatest  of  philosophers  has  said  that 
a  man's  nature  is  best  proved,  not  in  the  business 
of  life,  but  in  festive  intercourse ;  and  at  our  round 
table  we  have  all  had  opportunities  of  proving 
how  good  was  the  best  in  the  nature  of  our 
friend. 

For  six  generations  this  home  of  the  medical 
profession  in  America  has  never  wanted  broad- 
minded  representatives  whose  talents  were  not 
restricted  within  the  limits  of  their  art.  Such  men 
as  Casper  Wistar,  Rush,  Chapman,  and  Leidy — to 
mention  only  typical  illustrations — have  passed  into 
the  history  of  this  city,  famous  in  literature  or 
science,  pursuits  peculiarly  adapted  to  the  retired 
life  of  the  physician.  When  the  wider  field  of 
public  service  has  been  sought,  it  has  almost  invari- 
ably been  at  the  loss  of  all  active  interest  in  medicine. 
For  the  first  time  in  this  country  the  medical  pro- 
fession produced  in  the  person  of  William  Pepper 
a  man  of  affairs  of  the  first  rank,  whose  work  as  an  an 
organizer  will  compare  with  the  very  best,  and  this  ^^S^^^^er ; 
at  a  period  of  our  history  when  the  value  of  organ- 
ization had  become  fully  appreciated. 

That  amid  multifarious  duties  and  cares  he  should  undiminish- 
have  retained  to  the  last  an  undiminished  activity  in  ^*^  th^i^^t 
his  calling,  is  perhaps  the  greatest  tribute  to  his 
genius.    To  his  native  land  and  to  her  sons  he  gave 
freely  the  splendid  gifts  of  his  time  and  energies, 
but  to  us,  his  intimates,  he  gave  of  his  buoyancy, 

C2 


20 


HISTORY    AND 


his  hopefulness,  and  his  courage — and  they  remain 
to  cheer  us  on  the  remainder  of  our  way.  ^^ 

The  nature-  We  miss  now  the  quickening  spirit  and  the  wiser 
physicians,  jnsight  that  come  with  work  in  a  wide  field ;  and  in 
the  great  cities  of  this  country  we  look  in  vain 
among  practising  physicians  for  the  successor  of 
Jacob  Bigelow  of  Boston,  Holmes  of  Montreal, 
Barton  of  Philadelphia,  and  others — men  who  main- 
tained in  this  matter  an  honourable  tradition,  whose 
names  live  in  natural  history  societies  and  academies 
of  natural  science,  in  the  founding  of  which  they 
were  mainly  instrumental.  ^ 

August  22^  1662 — Black  Bartholomew's  Day,  as  it 
has  been  called — brought  sadness  and  sorrow  to 
many  English  homes.  The  enforcement  of  the  Act 
of  Uniformity  called  for  subscription  to  the  Thirty- 
nine  Articles,  and  enforced  the  use  by  all  clergymen 
of  the  Book  of  Common  Prayer.  Among  those 
ejected  for  refusal  to  subscribe — 2,000  in  number, 
it  is  said — was  a  young  man,  aged  twenty- five,  the 
Vicar  of  Kinver,  in  Staffordshire,  Richard  Morton 
by  name.  The  son  of  a  physician,  born  in  1 637,  he 
had  been  educated  at  Oxford,  where  he  took  the 
B.A.  in  1656-7,  became  chaplain  to  his  college  and 
took  the  MA.  in  1 659,  and  in  the  same  year  was 
appointed  to  the  vicarage  of  Kinver.  From  the  days 
of  St.  Luke  there  have  been  many  instances  of  what 
has  been  called  the  angelical  conjunction  of  physic 
and  divinity.  In  the  seventeenth  century  many  men 
could  sign  ^iKoO^oXoyiaTpovofjios  after  their  names,  as 


Richard 

Morton 

(1637-98) 


BIOGRAPHY  21 

did  Robert  Lovell  in  his  History  of  Animals  and 
Minerals  (1661).  Following  Linacre's  example, 
clerical  orders  have  been  taken  as  a  rule  by  the 
physician  late  in  life,  but  Morton,  ejected  from  his 
living,  turned  his  attention  to  medicine  at  a  com- 
paratively early  age.  From  Baxter's  account,  he 
evidently  was  a  loss  to  the  church.  He  speaks 
of  him  as  '  a  man  of  great  gravity,  calmness,  sound 
principles,  of  no  faction,  an  excellent  preacher,  of 
an  upright  life.' " 

In  one  of  Bassett's  last  letters  there  is  an  interest-  Broussais, 
ing  note  about  Broussais,  who  had  just  finished  his  (1772-1838). 
course  in  phrenology : — 

'  The  pupils  of  '36  have  struck  off  his  head.  It 
is  in  bronze,  a  little  less  than  our  old  Washington 
and  Franklin  in  wax.  Broussais  is  a  genius,  and 
when  he  entered  life  he  saw  that  something  was  to 
be  done,  or  rather  that  he  must  do  something,  and 
he  seized  the  science  of  medicine  as  a  good  old 
doctor  would  a  bottle  of  lotion,  and  shook  it  man- 
fully ;  France,  Germany,  all  Europe,  parts  of  Asia, 
and  America  have  felt  the  agitation.  But  younger 
men  also  feel  the  necessity  of  doing  something,  and 
they  are  now  endeavouring  to  quiet  the  commotion 
he  has  raised,  and  in  France  they  have  measurably 
succeeded.  When  the  giant  dies  I  doubt  if  he  will 
find  a  successor — his  conquests,  like  Alexander's, 
will  be  divided  and  then  fall  into  insignificance. 
He  fights  w^ell  while  in  the  ring  against  awful  odds, 
for  the  truth  is  against  him,  but  some  of  her  brightest 
geniuses  he  has  put  to  rout  or  silence.  Time  is 
now  about  to  enter  the  field,  and  I  have  no  doubt 
will  place  a  splendid  monument  over  him,  to  prevent 
him  from  being  forgotten.' " 


22 


HISTORY    AND 


Linacre, 
(1460-1524). 


American 
medicine. 


Linacre,  the  type  of  the  literary  physician,  must 
ever  hold  a  unique  place  in  the  annals  of  our 
profession.  To  him  was  due  in  great  measure  the 
revival  of  Greek  thought  in  the  sixteenth  century 
in  England;  and,  in  the  last  Harveian  oration, 
Dr.  Payne  has  pointed  out  his  importance  as  a  fore- 
runner of  Harvey.  He  made  Greek  methods 
available ;  through  him  the  art  of  Hippocrates  and 
the  science  of  Galen  became  once  more  the  subject 
of  careful,  first-hand  study.  * 

What  would  attract  us  all  is  the  study  of  the 
growth  of  the  American  mind  in  medicine  since  the 
starting  of  the  colonies.  As  in  a  mirror  this  story 
is  reflected  in  the  literature  of  which  you  are  the 
guardians  and  collectors — in  letters,  in  manuscripts, 
in  pamphlets,  in  books,  and  in  journals.  In  the 
eight  generations  which  have  passed,  the  men  who 
have  striven  and  struggled — men  whose  lives  are 
best  described  in  the  words  of  St.  Paul, '  in  journey- 
ings  often,  in  perils  of  waters, ...  in  perils  in  the  city, 
in  perils  in  the  wilderness,  in  perils  in  the  sea, .  .  . 
in  weariness  and  painfulness,  in  watchings  often,  in 
hunger  and  thirst,  in  fastings  often ' — these  men,  of 
some  of  whom  I  have  spoken,  have  made  us  what 
we  are.  With  the  irrevocable  past  into  which  they 
have  gone  lies  our  future,  since  our  condition  is  the 
resultant  of  forces  which,  in  these  generations,  have 
moulded  the  profession  of  a  new  and  mighty 
empire.  From  the  vantage-ground  of  a  young 
century  we  can  trace  in  the  literature  how  three 
great  streams  of  influence — English,  French,  and 


BIOGRAPHY  23 

German — have  blended  into  the  broad  current  of 
American  medicine  on  which  we  are  afloat. 
Adaptiveness,  lucidity,  and  thoroughness  may  be 
said  to  be  the  characteristics  of  the  Anglican,  Gallic, 
and  Teutonic  influences,  and  it  is  no  small  part  of 
your  duty  to  see  that  these  influences,  the  com- 
bination of  which  gives  to  medicine  on  this  continent 
its  distinctively  eclectic  quality,  are  maintained  and 
extended.  ^ 

One  of  the  most  complicated  problems  of  the  first  Fevers, 
half  of  the  century  related  to  the  differentiation  of  differentia- 
the  fevers.  The  eruptive  fevers,  measles,  scarlet 
fever,  and  small-pox,  were  easily  recognized,  and 
the  great  group  of  malarial  fevers  was  well  known ; 
but  there  remained  the  large  class  of  continued 
fevers,  which  had  been  a  source  of  worry  and 
dispute  for  many  generations.  ^ 

Louis  clearly  differentiated  typhoid  fever,  and 
by  the  work  of  his  American  pupils,  W.  W.  Gerhard 
and  Alfred  Stille  of  Philadelphia,  and  George 
Shattuck  of  Boston,  typhus  and  typhoid  fevers  were 
defined  as  separate  and  independent  affections.  ^ 

Relapsing  fever,  yellow  fever,  dengue,  &c.,  were 
also  distinguished.  The  work  of  Graves  and  Stokes 
of  Dublin,  of  Jenner  and  Budd  in  England,  of  Drake, 
Dickson,  and  Flint  in  America,  supplemented  the 
labours  of  the  French  physicians,  and  by  the  year  1 860 
the  profession  had  reached  a  sure  and  safe  position 
on  the  question  of  the  clinical  aspects  of  fevers. ' 


24 


HISTORY    AND 


Eryxima- 
chus. 


Evolution. 


Nowhere  in  literature  do  we  have  such  a  charming 
picture  illustrating  the  position  of  a  cultivated 
physician  in  society  as  that  given  in  VhiXXi's,  Dialogues 
of  Eryximachus^  himself  the  son  of  a  physician, 
Acumenus.  In  that  most  brilliant  age  the  physician 
was  the  companion  and  friend,  and  in  intellectual 
intercourse  the  peer,  of  its  choicest  spirits.  ''^ 

(^ 
In  no  way  has  biological  science  so  widened  the 
thoughts  of  men  as  in  its  application  to  social 
problems.  That  throughout  the  ages,  in  the  gradual 
evolution  of  life,  one  unceasing  purpose  runs ;  that 
progress  comes  through  unceasing  competition, 
through  unceasing  selection  and  rejection ;  in  a  word, 
that  evolution  is  the  one  great  law  controlling  all 
living  things,  '  the  one  divine  event  to  which  the 
whole  creation  moves,'  this  conception  has  been 
the  great  gift  of  biology  to  the  nineteenth  century.  ^' 

In  the  continual  remembrance  of  a  glorious  past  in- 
dividuals and  nations  find  their  noblest  inspiration.  ^' 

(^ 
Tyranny  of  The  ideal  has  been  reached,  so  far  as  organization 
Democracy.  £g  concerned,  when  the  profession  elects  its  own 
Parliament,  to  which  is  committed  the  control  of  all 
matters  relating  to  the  licence.  The  recognition 
in  some  form  of  this  democratic  principle  has  been 
one  great  means  of  elevating  the  standard  of  medical 
education,  and  in  a  majority  of  the  States  of  the 
Union  it  has  secured  a  minimum  period  of  four 
years'  study,  and  a  State  examination  for  licence  to 
practise.    All  this  is  as  it  should  be.    But  it  is  high 


The  past. 


BIOGRAPHY  25 

time  that  the  profession  realized  the  anomaly  of 
eight  boards  in  the  Dominion  and  some  scores  in 
the  United  States.  One  can  condone  the  iniquity 
in  the  latter  country  more  readily  than  in  Canada, 
in  which  the  boards  have  existed  for  a  longer 
period,  and  where  there  has  been  a  great  uniformity 
in  the  medical  curriculum.  After  all  these  years 
that  a  young  man,  a  graduate  of  Toronto  and 
a  registered  practitioner  in  Ontario,  cannot  practise 
in  the  province  of  Quebec,  his  own  country,  without 
submitting  to  vexatious  penalties  of  mind  and 
pocket,  or  that  a  graduate  from  Montreal  and 
a  registered  practitioner  of  this  province  cannot  go 
to  Manitoba,  his  own  country  again,  and  take  up 
his  life's  work  without  additional  payments  and 
penalties,  is,  I  maintain,  an  outrage;  it  is  pro- 
vincialism run  riot.  That  this  pestiferous  condition 
should  exist  throughout  this  Dominion  and  so  many 
States  of  the  Union,  illustrates  what  I  have  said  of 
the  tyranny  of  democracy,  and  how  great  enslavers 
of  liberty  its  chief  proclaimers  may  be.  ^^ 

My  feeling  on  the  subject  of  international,  inter-  Interpro- 
colonial,  and  interprovincial  registration  is  this —  i^ter-^ 
a  man  who  presents  evidence  of  proper  training,  national 
who  is  a  registered  practitioner  in  his  own  country,  I^,^^ 
and  who  brings  credentials  of  good  standing  at  the 
time  of  departure,  should  be  welcomed  as  a  brother, 
treated  as  such  in  any  country,  and  registered  upon 
payment  of  the  usual  fee.     The  ungenerous  treat- 
ment of  English  physicians  in  Switzerland,  France, 
and  Italy,  and  the  chaotic  state  of  internecine  war- 


26  HISTORY   AND 

fare  existing  on  this  continent,  indicate  how  far 
a  miserable  Chauvinism  can  corrupt  the  great  and 
gracious  ways  which  should  characterize  a  liberal 
profession.  ^^ 

Back  to  Like  everything  else  that  is  good  and  durable  in 
the  Greeks,  ^j^-g  ^orld,  modern  medicine  is  a  product  of  the 
Greek  intellect,  and  had  its  origin  when  that  wonder- 
ful people  created  positive  or  rational  science,  and 
no  small  credit  is  due  to  the  physician  who,  as 
Professor  Gomperz  remarks  (in  his  chapter,  'On 
the  Age  of  Enlightenment,'  Greek  Thinkers^  vol.  i), 
very  early  brought  to  bear  the  spirit  of  criticism  on 
the  arbitrary  and  superstitious  view  of  the  pheno- 
mena of  life.  If  science  was  ever  to  acquire  '  steady 
and  accurate  habits  instead  of  losing  itself  in  a  maze 
of  phantasies,  it  must  be  by  quiet  methodical 
research.'  'It  is  the  undying  glory  of  the  school 
of  Cos  that  it  introduced  this  innovation  into  the 
domain  of  its  art,  and  thus  exercised  the  most 
beneficial  influence  on  the  whole  intellectual  life  of 
mankind.  Fiction  to  the  right !  reality  to  the  left ! 
was  the  battle-cry  of  this  school  in  the  war  which 
it  was  the  first  to  wage  against  the  excesses  and 
defects  of  the  nature  philosophy.'  (Gomperz.)  The 
critical  sense  and  sceptical  attitude  of  the  Hippo- 
cratic  school  laid  the  foundation  of  modern  medicine 
on  broad  lines,  and  we  owe  to  it:  first,  the 
emancipation  of  medicine  from  the  shackles  of 
priestcraft  and  of  caste ;  secondly,  the  conception  of 
medicine  as  an  art  based  on  accurate  observation, 
and,  as  a  science,  an  integral  part  of  the  science 


BIOGRAPHY  27 

of  man  and  of  nature ;  thirdly,  the  high  moral 
ideals  expressed  in  that '  most  memorable  of  human 
documents '  (Gomperz),  the  Hippocratic  oath  ;  and 
fourthly,  the  conception  and  realization  of  medicine 
as  a  profession  of  a  cultivated  gendeman.  ^^ 

.    .       .     .    ^ 
The  most  distinguishing  feature  of  the  scientific  Experi- 

medicine  of  the  century  (nineteenth)  has  been  the  ^^°}^  *" 
phenomenal  results  which  have  followed  experi-  boratory. 
mental  investigation.  While  this  method  of  re- 
search is  not  new,  since  it  was  introduced  by  Galen, 
perfected  by  Harvey,  and  carried  on  by  Hunter,  it 
was  not  until  well  into  the  middle  of  the  century 
that,  by  the  growth  of  research  laboratories,  the 
method  exercised  a  deep  influence  on  progress. 
The  lines  of  experimental  research  have  sought  to 
determine  the  functions  of  the  organs  in  health,  the 
conditions  under  which  perversion  of  these  functions 
occurs  in  disease,  and  the  possibility  of  exercising 
protective  and  curative  influences  on  the  process  of 
disease.  ^ 

Not  only  has  experimental  science  given  us  clear 
and  accurate  data  upon  the  localization  of  certain 
functions  of  the  brain,  and  of  the  paths  of  sensory 
and  of  motor  impulses,  but  it  has  opened  an  entirely 
new  field  in  the  diagnosis  and  treatment  of  the 
diseases  of  these  organs,  in  certain  directions  of 
a  most  practical  nature,  enabling  us  to  resort  to 
measures  of  relief  undreamedof  even  thirty  years  ago.^ 

The  study  of  physiology  and  pathology  within 
the  past  half-century  has  done  more  to  emancipate 


28 


HISTORY   AND 


Experi- 
ments : 

clinical. 


Laennec 
(1781-1826). 


Reform  in 
medicine  in 
America. 


medicine  from  routine  and  thraldom  of  authority 
than  all  the  work  of  all  the  physicians  from  the 
days  of  Hippocrates  to  Jenner,  and  we  are  as  yet 
upon  the  threshold.  ^ 

As  clinical  observers  we  study  the  experiments 
which  Nature  makes  upon  our  fellow  creatures. 
These  experiments,  however,  in  striking  contrast 
to  those  of  the  laboratory,  lack  exactness,  possess- 
ing as  they  do  a  variabiHty  at  once  a  despair  and  a 
delight — the  despair  of  those  who  look  for  nothing 
but  fixed  laws  in  an  art  which  is  still  deep  in  the 
sloughs  of  empiricism  ;  the  delight  of  those  who 
find  in  it  an  expression  of  a  universal  law  transcend- 
ing, even  scorning,  the  petty  accuracy  of  test-tube 
and  balance,  the  law  that  in  man,  '  the  measure  of 
all  things,'  mutability,  variability,  mobility,  are  the 
very  marrow  of  his  being.  '^ 

The  discovery  by  Laennec  of  the  art  of  auscultation, 
by  which,  through  changes  in  the  normal  sound 
within  the  chest,  various  diseases  of  the  heart  and 
lungs  could  be  recognized,  gave  an  immense  impetus 
to  clinical  research.  The  art  of  percussion,  dis- 
covered by  Auenbrugger  in  the  eighteenth  century, 
and  reintroduced  by  Corvisart,  contributed  not  a 
little  to  the  same.  Laennec's  contributions  to  the 
study  of  disease  of  the  lungs,  of  the  heart,  and  of 
the  abdominal  organs  really  laid  the  foundation  of 
modern  clinical  medicine.  ^ 

The  reformation  which  started  at  Harvard  shortly 


BIOGRAPHY  29 

after  1870  spread  over  the  entire  country,  and  the 
rapid  evolution  of  the  medical  school  has  been  one 
of  the  most  striking  phenomena  in  the  history  of 
medicine  in  the  century.  University  authorities 
began  to  appreciate  the  fact  that  medicine  was 
a  great  department  of  knowledge,  to  be  cultivated 
as  a  science  and  promoted  as  an  art.  Wealthy  men 
felt  that  in  no  better  way  could  they  contribute  to 
the  progress  of  the  race  than  by  the  establishment 
of  laboratories  for  the  study  of  disease,  and  hospitals 
for  the  care  of  the  sick  poor.  The  benefactions  of 
Johns  Hopkins,  of  Sims,  of  VanderbUt,  of  Pierpont 
Morgan,  of  Strathcona,  of  Mount-Stephen,  of 
Payne,  and  of  Levi  C.  Lane  and  others  have  placed 
scientific  medicine  on  a  firm  basis.  ^ 

With  the  invention  of  the  microscope  we  can  Microscope, 

mark  the  first  positive  step  towards  the  goal  to-day.  *^®  |?" 
AT-         .  T^-     1         •        ^  ^      n  ventionof 

A  Jesuit  priest,  Kircher,  in  1 671,  was  the  first  to  (1671). 

investigate  putrefying  meat,  milk,  and  cheese  with 
the  crude  microscope  of  his  day,  and  left  us  in- 
definite remarks  concerning  'very  minute  living 
worms '  found  therein.  Four  years  after  Kircher  a 
Dutch  linen  merchant,  Antonius  von  Leeuwenhoek, 
by  improving  the  lenses  of  the  microscope,  saw  in 
rain -water,  putrefying  fluids,  intestinal  contents, 
and  saliva,  minute,  moving,  living  particles,  which 
he  called  '  animalculae.'  In  medical  circles  of  his 
day  these  observations  aroused  the  keenest  interest, 
and  the  theory  that  these  '  animalculae '  might  be 
the  cause  of  all  disease  was  eagerly  discussed. 
Plenciz,  of  Vienna,  after  much  observation  of  various 


30  HISTORY   AND 

fluids,  putrefying  and  otherwise,  wrote,  in  1762, 
that  it  was  his  firm  belief  that  the  phenomena  of 
diseases  and  the  decomposition  of  animal  fluids 
were  wholly  caused  by  minute  living  things.  ^ 


Medicine  in  It  may  be  interesting  to  take  a  glance  at  the  state 

America  at  ^f  medicine  in  this  country  at  the  opening-  of  the 
opening  of  r  a       1  .  .    .         .  ^  . 

nineteenth    century.     [At  the  opening  of  the  nineteenth  cen- 

century.  tury]  there  were  only  three  schools  of  medicine, 
the  most  important  of  which  were  the  University 
of  Pennsylvania  and  the  Harvard.  There  were 
only  two  general  hospitals.  The  medical  education 
was  chiefly  in  the  hands  of  the  practitioners  who 
took  students  as  apprentices  for  a  certain  number 
of  years.  The  well-to-do  students  and  those  wishing 
a  better  class  of  education  went  to  Edinburgh  or 
London.  There  were  only  two  or  three  medical 
journals,  and  very  few  books  had  been  published 
in  the  country,  and  the  profession  was  dependent 
entirely  upon  translations  from  the  French  and 
upon  English  works.  The  only  medical  libraries 
were  in  connexion  with  the  Pennsylvania  Hospital 
and  the  New  York  Hospital.  The  leading  prac- 
titioners in  the  early  years  were  Rush  and  Physick 
in  Philadelphia  ;  Hosack  and  Mitchill  in  New  York ; 
and  James  Jackson  and  John  Collins  Warren  in 
Boston.  There  were  throughout  the  country,  in 
smaller  places,  men  of  great  capabilities  and  energy, 
such  as  Nathan  Smith,  the  founder  of  the  Medical 
Schools  of  Dartmouth  and  of  Yale,  and  Daniel 
Drake  in  Cincinnati.  ^ 


BIOGRAPHY  31 

The  well-known  effect  on  angina  pectoris  of  John 
mental  emotion  has  never  been  better  expressed  7V^^^^  ) 
than  by  John  Hunter,  who  used  to  say  that  '  his  life 
was  in  the  hands  of  any  rascal  who  chose  to  annoy 
and  tease  him.'  And  yet  some  of  the  victims  of 
angina  have  not  found  mental  excitement  to  be  the 
most  serious  exciting  cause.  Thus,  in  Mr.  Sumner's 
case,  '  a  sudden  turn  in  his  easy  chair,  while  quietly 
reading  at  night,  would  start  up  the  most  tearing 
agony,  while  at  other  times  an  exciting  speech  in 
the  Senate,  accompanied  with  the  most  forcible 
and  muscular  gesticulations,  would  not  create  even 
the  suggestion  of  a  pain.'    (Taber  Johnson.)  ^^ 

Harvey  and  Sydenham,  types  of  the  scientific  and  Harvey 

the    practical    physician,   though  contemporaries,  ^^578-1658). 

were  uninfluenced,  so  far  as  we  know,  by  each  other's  (1624-80)" 

work  or  method.     Harvey  had  little  reputation  as 

a  practical  physician,  and  Sydenham  cared  little  for 

theories  or  experiment.  Modern  scientific  medicine, 

in  which  these  two  great  types  meet,  had  its  rise 

in  France  in  the  early  days  of  this  century.     True, 

there  had  lived  and  worked  in  England  the  greatest 

anatomist  and  medical  thinker  of  modern  times ; 

but  John  Hunter,  to  whose  broad  vision  disease 

was  but  one  of   the  processes   of  nature   to  be 

studied,  was  as  a  voice  crying  in  the  wilderness  to 

the  speculative,  theoretical  physicians  of  his  day.  ^ 

The  chief  facts  in  Louis's  life  may  be  thus  briefly  Louis 
stated.  He  was  born  in  1787  at  Af.  He  began  the  (1787- 
study  of  law,  but  abandoned  it  for  that  of  medicine. 


32 


HISTORY   AND 


practised 
in  Odessa 
for  four 
years ; 


but  re- 
turned to 
the  hos- 
pitals for 
six  years 
for  clinical 
study ; 


He  seems  not  to  have  been  of  a  very  strong  con- 
stitution, as  he  did  not  pass  the  inspection  for 
military  service.  He  began  the  study  of  medicine 
at  Rheims,  and  completed  his  course  in  Paris,  where 
he  graduated  in  1813,  in  the  twenty-seventh  year 
of  his  age.  While  waiting  at  home,  hesitating  what 
he  should  do,  M.  le  comte  de  Saint-Priest,  who 
occupied  an  official  position  in  Russia,  happened  to 
stay  for  a  few  hours  in  the  town  of  Aif  to  see  Louis's 
family,  and  it  was  suggested  that  the  young  physi- 
cian should  accompany  him  to  Russia.  He  con- 
sented, and  in  St.  Petersburg  obtained  a  diploma 
to  practise.  For  three  years  he  seems  to  have  had 
no  settled  abode,  but  wandered  about  with  his 
friend,  who  was  governor  of  one  of  the  provinces. 
He  then  settled  in  Odessa,  where  he  remained  for 
four  years  and  practised  with  g^eat  success.  In 
the  last  year  of  his  stay  in  Odessa  he  was  very 
much  disturbed  by  the  high  rate  of  mortality  in 
children  with  diphtheria,  and  this  appears  to  have 
determined  him  to  abandon  for  a  time  the  practice 
of  medicine  and  to  devote  himself  to  study.  With 
this  object  in  view  he  returned  to  Paris,  and  for 
six  months  attended  the  practice  at  the  Children's 
Hospital.  Among  the  younger  physicians  in  Paris 
he  found  an  old  fellow  pupil,  Chomel,  physician  to 
La  Charite,  who  offered  him  opportunities  for  work 
in  his  wards.  Louis  was  at  this  time  thirty-four 
years  of  age.  Here  for  six  years  uninterruptedly 
he  set  himself  to  work  to  study  disease  in  the  wards 
and  in  the  post-mortem  room.  At  first  he  appears 
to  have  occupied  the  position  simply  as  a  voluntary 


BIOGRAPHY  33 

assistant  and  friend  of  Chomel,  but  subsequently  he 
became  his  chef  de  clinique^  and  during  this  period 
he  occupied  a  room  in  the  entresol  of  the  hospital. 
He  was  a  voluminous  note-taker  and  collected  in 
this  time  an  enormous  number  of  important  facts.  ^ 

This  remarkable  feature  in  Louis's  life  has  scarcely- 
been  dwelt  upon  sufficiently.  I  know  of  no  other 
parallel  instance  in  the  history  of  medicine.  It  is 
worth  while  reading-  the  brief  extract  from  Dr. 
Cowan's  introduction  to  his  translation  of  the  work 
on  Phthisis : — 

'  He  entered  the   hospital  of  La  Charite   as  a 
clinical  clerk^  under  his  friend,  Professor  Chomel. 
For  nearly  seven  years,  including  the  flower  of  minuteness 
his  bodily  and  mental   powers  (from  the   age  of  of  inquiry 
thirty-three  to  forty),  he   consecrated   the  whole  ^"^^  ^^' 
of  his   time   and   talents   to  rigorous^   impartial  description- 
observation.    All  private  practice  was  relinquished, 
and  he  allowed  no  considerations  of  personal  emo- 
lument  to   interfere   with   the   resolution   he   had 
formed.     For  some  time  his  extreme  minuteness 
of  inquiry  and  accuracy  of  description  were  the 
subjects  of  sneering  and  ridicule,  and  Cui  bono  ?  Cui 
was  not  infrequently  and  tauntingly  asked.      The  bono? 
absence  of  any  immediate  result  seemed  for  a  time 
to  justify  their  contempt  of  a  method  involving  too  his  method 
much  labour  and  personal  sacrifice  to  be  generally  spoken  of 
popular  or  easily  imitated ;  and  M.  Louis  himself,  ^    ^f  P'^' 
at  moments,  almost  yielded  to  the  increasing  diffi- 
culties of  the  task  he  had  undertaken.     No  sooner, 
however,  were  his  facts  sufficiently  numerous   to 
admit  of  numerical  analysis   than   all   doubt  and 
hesitation  were  dissipated,  and  the  conviction  that 
the  path  he  was  pursuing  could  alone  conduct  him 
to  the  discovery  of  truth  became  the  animating 


34 


HISTORY   AND 


but  later 
applauded 
and  imi- 
tated ; 


motive  for  future  perseverance.  Many  of  the 
results  at  which  he  arrived  soon  attracted  general 
attention,  and  among  those  who  had  formerly- 
derided  his  method  while  they  admired  his  zeal, 
he  found  many  to  applaud  and  a  few  to  imitate. 
From  this  moment  may  be  dated  the  presence  of 
that  strong  impression  of  the  necessity  of  exact 
observation  by  which  the  school  of  Paris  has  been 
since  so  distinguished,  and  which  is  now  gradually 
pervading  the  medical  institutions  of  the  continent 
and  our  own  country  ;  it  is  undoubtedly  to  the 
author  of  the  present  volume  that  we  ought  to 
ascribe  the  practical  revival  of  that  system,  which 
had  for  ages  been  verbally  recognized,  but  never 
before  rigorously  exemplified,'  ^ 


the  Numeri- 
cal Method, 


by  which  is 
obtained 
facts  upon 
which  the 
edifice  of 
medicine 
must  rest ; 


Louis  introduced  what  is  known  as  the  Numerical 
Method,  a  plan  which  we  use  every  day,  though 
the  phrase  is  not  now  very  often  on  our  lips.  The 
guiding  motto  of  his  life  was  Ars  medica  iota  in 
observationibus^  in  carefully  observing  facts,  care- 
fully collating  them,  carefully  analysing  them.  To 
get  an  accurate  knowledge  of  any  disease  it  is 
necessary  to  study  a  large  series  of  cases  and  to  go 
into  all  the  particulars — the  conditions  under  which 
it  is  met,  the  subjects  specially  liable,  the  various 
symptoms,  the  pathological  changes,  the  effect  of 
drugs.  This  method,  so  simple,  so  self-evident,  we 
owe  largely  to  Louis,  in  whose  hands  it  proved  an 
invaluable  instrument  of  research.  He  remarks  in 
one  place  that  the  edifice  of  medicine  reposes 
entirely  upon  facts,  and  that  truth  cannot  be  elicited 
but  from  those  which  have  been  well  and  com- 
pletely observed.  -^ 


BIOGRAPHY  35 

American  medicine  felt  the  influence  of  Louis  Louis's 
through  two  channels,  his  books  and  his  pupils,  phannels  of 
Let  us  speak  first  of  the  former.  No  French  writer 
of  the  century  has  had  such  a  large  audience  in  this 
country ;  all  of  his  important  works  were  translated 
and  widely  read  (Louis).  The  work  on  Phthisis, 
the  first  important  outcome  of  five  years'  hard  work 
at  La  Charite  in  Chomel's  wards,  was  published  in 
1825.  Much  had  already  been  done  by  physicians 
of  the  French  school  on  this  subject.  Bayle's  im- 
portant Recherches  had  been  issued  in  18 10,  and 
Laennec  had  revolutionized  the  study  of  phthisis 
by  the  publication  of  his  treatise  on  auscultation. 
I  cannot  enter  into  any  detailed  analysis  of  the 
work,  but  it  is  one  which  I  can  commend  to  your 
notice  as  still  of  great  value,  particularly  as  a  model 
of  careful  observation.  The  work  was  based  upon 
the  study  of  123  cases  observed  in  Chomel's  clinic. 
The  lesions  observed  at  autopsy  are  first  described 
under  the  different  organs,  with  great  accuracy  and 
detail,  and  then  summarized,  following  which  is  an 
elaborate  description  of  the  symptomatology.  I  do 
not  know  of  any  single  work  on  pulmonary  tubercu- 
losis which  can  be  studied  with  greater  profit  to-day 
by  the  young  physician.  The  fifty  years  which  have 
elapsed  since  its  publication,  and  the  changes  which 
have  taken  place  in  our  ideas  of  tuberculosis,  detract 
naught  from  the  value  of  his  careful  anatomical  and 
clinical  presentation  of  the  subject.  ^ 

Oliver  Wendell  Holmes  said  that  he  had  learned  1"®  teach- 
ing and 
three  things  in  Paris :  '  Not  to  take  authority  when  influence ; 

D  2 


36 


HISTORY   AND 


his  Ameri- 
can pupils 
in  Paris 
between 
1830  and 
1840. 


I  can  have  facts,  not  to  guess  when  I  can  know, 
and  not  to  think  a  man  must  take  physic  because 
he  is  sick.'  It  seems  to  me  that  this  group  of 
young  fellows  brought  back  from  Paris,  first,  an 
appreciation  of  the  value  of  method  and  accuracy 
in  the  study  of  the  phenomena  of  disease ;  secondly, 
a  profound,  and  at  the  time  a  much-needed,  dis- 
trust of  drugs  ;  and,  thirdly,  a  Gallic  refinement  and 
culture  which  stamped  them,  one  and  all,  as  un- 
usual men.  Let  me  name  the  list  over  as  given  to 
me  by  Stille*  himself: — 

'  From  Boston :  James  Jackson,  Jr.,  H.  I.  Bow- 
ditch,  O.  W.  Holmes,  George  C.  Shattuck,  Jr.,  John 
C.  Warren  (then  past  middle  age),  John  Mason 
Warren,  and  John  D.  Fisher.  From  Philadelphia  : 
George  W.  Norris,  William  W.  Gerhard,  Casper 
W.  Pennock,  Thomas  Stewardson,  Alfred  Stille, 
Thomas  L.  Mutter,  E.  Campbell  Stewart,  Charles 
Bell  Gibson,  John  B.  Biddle,  David  H.  Tucker, 
Meredith  Clymer,  William  P.  Johnston,  W.  S.  W. 
Ruschenburger,  Edward  Peace,  William  Pepper,  Sr. 
Baltimore  :  William  Power  (see  biography  of 
Charles  Frick,  in  Gross's  Lives).  Charleston : 
G.  S.  Gibbes,  Peter  C.  Gaillard,  Pryce  Porcher. 
Virginia :  J.  L.  Cabell,  L.  S.  Joynes,  —  Selden,  and 
—  Randolph.  New  York  :  John  A.  Swett,  Abraham 
Dubois,  Alonzo  Clark,  Charles  L.  Mitchell,  — 
Punnet,  Charles  D.  Smith,  Valentine  Mott,  Sr., 
[and]  John  T.  Metcalfe.' 

There  were  many  others,  of  course,  some  before 
Louis's  day, as  Samuel  G.Morton,  who  was  Laennec's 
most  distinguished  American  pupil,  and  some  of 
those  mentioned,  as    Meredith  Clymer  {ultimus 

*  Died  April  20,  1902. 


BIOGRAPHY  37 

Romanorum)  and  Metcalfe,  just  gone  (1902),  who 
did  not  come  so  directly  under  Louis's  influence, 
but  were  pupils  of  Chomel  and  Andral.  ^^ 

*And  many  more  whose  names  on  earth  are  dark' — 
men  of  the  stamp  of  Dr.  Bassett  of  Alabama,  who 
felt  the  strong  impulsion  to  know  the  best  that  the 
world  offered,  every  one  of  whom  has  left  a  deep 
and  enduring  impression  in  his  sphere  of  work.  ^ 

As  Sir  Thomas  Browne  remarks  in  the  Hydrio-  Thomas 
taphia :  '  The  iniquity  of  oblivion  blindly  scatter-  Pgg^^ 
eth  her  poppy,  and   deals   with  the  memory  of  1742): 

men  without  distinction  to  merit  of  perpetuity.' 
Thus  it  happens  that  Thomas  Dover,  the  doctor, 
has  drifted  into  our  modern  life  on  a  powder 
label  (to  which  way  of  entering  the  company  of 
posterity,  though  sanctified  by  Mithridates,  many 
would  prefer  oblivion,  even  to  continuous  im- 
mortality on  a  powder  so  potent  and  palatable 
as  the  Pulvis  Ipecacuanhae  coitiposiius) ;  while 
Thomas  Dover,  the  buccaneer,  third  in  command, 
one  of  the  principal  owners,  and  president  of  the 
council  of  the  Duke  and  Duchess — privateers  of 
the  ancient  and  honourable  city  of  Bristol — dis- 
coverer of  Alexander  Selkirk  (the  original  Robinson 
Crusoe),  in  spite  of  more  enduring  claims  on  our 
gratitude,  has  been  forgotten.  ^ 

a  good 

Doubtless  the  old  buccaneer,  described  as  '  a  man  fighter  and 

of  rough  temper,  who  could  not  easily  agree  with  u  Ag°  7 


38 


HISTORY    AND 


discoverer 
of '  Robin- 
son 
Crusoe ' ; 


Dover's 
Powder. 


those  about  him,'  was  a  striking  figure  as  he  passed 
along  the  Strand  to  the  Jerusalem  Coffee  House, 
where  he  saw  his  patients.  A  good  fighter,  a  good 
hater,  as  alas !  so  many  physicians  have  been,  his 
weaknesses  and  evil  behaviour  we  may  forget,  but 
Captain  Thomas  Dover,  who  on  the  2nd  of  February, 
1 7 10,  found  'Robinson  Crusoe,' the  world  should 
not  forget ;  and  we  also  of  his  craft  have  cause  daily 
to  remember  with  gratitude  the  student  and  friend  of 
the  great  Sydenham,  who  had  the  wit,  in  devising 
a  powder,  to  remember  his  master's  injunction : 
Sine papaveribus^  sine  opiatis  et  medic anientis^  ex 
iis  confectis^  manca  et  clauda  esset  vtedicina.  ^^ 


Oliver 
Wendell 
Holmes 
(1809-94) 


*  one-hoss 
shay '  ; 


Very  fitting  indeed  is  it  that  he  who  had  lived  to 
be  '  the  last  leaf  upon  the  tree  '  should  have  fallen 
peacefully  in  the  autumn  which  he  loved  so  well. 
Delightful,  too,  to  think  that  although  he  had,  to 
use  the  expression  of  Benjamin  Franklin,  intruded 
himself  these  many  years  into  the  company  of 
posterity,  the  freshness  and  pliancy  of  his  mind 
had  not  for  a  moment  failed.  Like  his  own  wonder- 
ful '  one-hoss  shay,'  the  end  was  a  sudden  break- 
down ;  and  though  he  would  have  confessed,  no 
doubt,  to  '  a  general  flavor  of  decay,*  there  was 
nothing  local,  and  his  friends  had  been  spared 
that  most  distressing  of  all  human  spectacles,  those 
cold  gradations  of  decay,  in  which  a  man  takes 
nearly  as  long  to  die  as  he  does  to  grow  up,  and 
lives  a  sort  of  death  in  life,  ita  sine  vita  vivere^  ita 
sine  morte  mori.  ^^ 


BIOGRAPHY  39 

He  has  been  sandwiched  in  my  affections  these  the  Ameri- 

many  years  between  Oliver  Goldsmith  and  Charles  s^th  and 

Lamb.     More  than  once  he  has  been  called,  I  think, 

the    American    Goldsmith.      Certainly    the    great 

distinction  of  both  men  lies  in  that  robust  humanity 

which  has  a  smile  for  the  foibles  and  a  tear  for  the 

sorrows  of  their   fellow  creatures.      The  English  the  English 

Oliver,  with  a  better  schooling  for  a  poet  (had  he  Goldsmith; 

not  learned  in  suffering  what  he  taught  in  song  ?), 

had  a  finer  fancy  and  at  his  best  a  clearer  note. 

With  both  writers  one  is  at  a  loss  to  know  which 

to  love  the  better,  the  prose  or  the  poetry.     Can 

we  name  two  other  prose-writers  of  equal  merit, 

who  have  so  successfully  courted  the  '  draggle-tailed 

Muses,'  as   Goldsmith   calls  them  ?    Like  Charles  Holmes  and 

Lamb,  Holmes  gains  the  affections  of  his  readers  ^^™°5 

at   the   first   sitting,  and   the   genial  humour,  the 

refined  wit,   the   pathos,   the   tender  sensitiveness 

to  the   lights  and  shadows  of  life,   give   to   the 

Breakfast  Table  Series  much  of  the  charm  of  the 

Essays  of  Elia.  ^^ 

A  few  years  later,  however,  he  contributed  an 
article  which  will  long  keep  his  memory  green 
in  our  ranks. 

Child-bed  fever  was  unhappily  no  new  disorder  puerperal 
when  Oliver  Wendell  Holmes  studied,  nor  had  '^v**"  I 
there  been  wanting  men  who  had  proclaimed 
forcibly  its  specific  character  and  its  highly  con- 
tagious nature.  Indeed,  so  far  back  as  1 795,  Gordon, 
of  Aberdeen,  not  only  called  it  a  specific  contagion, 
but  said  he  could  predict  with  unerring  accuracy 


40 


HISTORY   AND 


his  great, 
contribu- 
tion to 
science ; 


the  very  doctors  and  nurses  in  whose  practice  the 
cases  would  develop.  Rigby,  too,  had  lent  the 
weight  of  his  authority  in  favour  of  the  contagious- 
ness, but  the  question  was  so  far  from  settled  that, 
as  you  will  hear,  many  of  the  leading  teachers 
scouted  the  idea  that  doctors  and  nurses  could 
convey  the  disorder.  Semmelweis  had  not  then 
begun  to  make  his  interesting  and  conclusive  ob- 
servations, for  which  his  memory  has  recently  been 
greatly  honoured. 

In  1842,  before  the  Boston  Society  for  Medical 
Improvement,  Dr.  Holmes  read  a  paper  entided 
'  The  Contagiousness  of  Puerperal  Fever,'  in  which 
he  brought  forward  a  long  array  of  facts  in  support 
of  the  view  that  the  disease  was  contagious,  con- 
veyed usually  by  the  doctor  or  the  nurse,  and  due 
to  a  specific  infection.  At  the  time  there  certainly 
was  not  an  article  in  which  the  subject  was  presented 
in  so  logical  and  so  convincing  a  manner.  As 
Sydney  Smith  says,  it  is  not  the  man  who  first  says 
a  thing,  but  it  is  he  who  says  it  so  long,  so  loudly, 
and  so  clearly  that  he  compels  men  to  hear  him — 
it  is  to  him  that  the  credit  belongs ;  and  so  far 
as  this  country  is  concerned,  the  credit  of  insisting 
upon  the  great  practical  truth  of  the  contagiousness 
of  puerperal  fever  belongs  to  Dr.  Holmes.  The 
essay  is  characterized  in  places  by  intenseness  and 
great  strength  of  feeling.  He  says  he  could  not 
for  a  moment  consent  to  make  a  question  of  the 
momentous  fact,  which  should  not  be  considered 
a  subject  for  trivial  discussion,  but  which  should 
be  acted  upon  with  silent  promptitude.     '  No  nega- 


BIOGRAPHY 


41 


tive  facts,  no  passing  opinions,  be  they  what  they 
may,  can  form  any  answer  to  the  series  of  cases 
now  within  the  reach  of  all  who  choose  to  explore 
the  records  of  medical  science.'  Just  before  the 
conclusions  the  following  eloquent  sentences  are 
found,  portions  of  which  are  often  quoted  : — 

'  It  is  as  a  lesson  rather  than  as  a  reproach,  that  I  an  historic 
call  up  the  memory  of  these  irreparable  errors  and  paragraph ; 
wrongs.  No  tongue  can  tell  the  heart-breaking 
calamities  they  have  caused ;  they  have  closed  the 
eyes  just  opened  upon  a  new  world  of  life  and 
happiness ;  they  have  bowed  the  strength  of  man- 
hood into  the  dust ;  they  have  cast  the  helplessness 
of  infancy  into  the  stranger's  arms,  or  bequeathed 
it  with  less  cruelty  the  death  of  its  dying  parent. 
There  is  no  tone  deep  enough  for  record,  and 
no  voice  loud  enough  for  warning.  The  woman 
about  to  become  a  mother,  or  with  her  new-born 
infant  upon  her  bosom,  should  be  the  object  of 
trembling  care  and  sympathy  wherever  she  bears 
her  tender  burden,  or  stretches  her  aching  limbs. 
The  very  outcast  of  the  street  has  pity  upon  her 
sister  in  degradation  when  the  seal  of  promised 
maternity  is  impressed  upon  her.  The  remorseless 
vengeance  of  the  law  brought  down  upon  its 
victims  by  a  machinery  as  sure  as  destiny,  is  arrested 
in  its  fall  at  a  word  which  reveals  her  transient 
claims  for  mercy.  The  solemn  prayer  of  the  liturgy 
singles  out  her  sorrows  from  the  multiplied  trials 
of  life,  to  plead  for  her  in  the  hour  of  peril.  God 
forbid  that  any  member  of  the  profession  to  which 
she  trusts  her  life^  doubly  precious  at  that  eventful 
period,  should  regard  it  negligently,  unadvisedly, 
or  selfishly.' 

The   results   of  his  studies  are  summed  up  in  puerperal 
a  series  of  eight  conclusions,  and  the  strong  ground  fever,  not 


42 


HISTORY    AND 


a  misfor- 
tune but  a 
crime ; 


essay  on 
Puerperal 
Fever,  and 
the  Cham- 
bered 
Nautilus. 


which  he  took  may  be  gathered  from  this  sentence 
in  the  last  one :  '  The  time  has  come  when  the 
existence  of  a  private  pestilence  in  the  sphere  of 
a  single  physician  should  be  looked  upon  not  as 
a  misfortune  but  a  crime.'  Fortunately  this  essay, 
which  was  published  in  the  ephemeral  JVew  England 
Quarterly  Journal  of  Medicine^  was  not  destined 
to  remain  unnoticed.  The  statements  were  too 
bold  and  the  whole  tone  too  resolute  not  to  arouse 
the  antagonism  of  those  whose  teachings  had  been 
for  years  diametrically  opposed  to  the  contagious- 
ness of  puerperal  fever.  ^^ 

Some  years  ago  in  an  editorial  note  I  commented 
upon  a  question  which  Dr.  Holmes  had  asked  in  his 
Hundred  Days  171  Europe.  Somewhere  at  dinner 
he  had  sat  next  to  a  successful  gynaecologist  who 
had  saved  some  hundreds  of  lives  by  his  operations, 
and  he  asked,  '  Which  would  give  the  most  satis- 
faction to  a  thoroughly  humane  and  unselfish  being, 
of  cultivated  intelligence  and  lively  sensibilities  :  to 
have  written  all  the  plays  which  Shakespeare  has 
left  as  an  inheritance  for  mankind,  or  to  have 
snatched  from  the  jaws  of  death  more  than  a  hun- 
dred fellow  creatures,  and  restored  them  to  sound 
and  comfortable  existence  ? '  I  remarked  that  there 
was  nobody  who  could  answer  this  question  so 
satisfactorily  as  the  Autocrat,  and  asked  from  which 
he  derived  the  greater  satisfaction,  the  essay  07t 
Puerperal  Fever ^  which  had  probably  saved  many 
more  lives  than  any  individual  gynaecologist,  or 
the  Chambered  Nautilus^  which  had  given  pleasure 


BIOGRAPHY  43 

to  so  many  thousands.  The  journal  reached  Dr. 
Holmes,  and  I  read  you  his  reply  to  me,  under  date 
of  January  21,  1889: — 

'  I  have  been  rarely  more  pleased  than  by  your 
allusion  to  an  old  paper  of  mine.  There  was  a  time 
certainly  in  which  I  would  have  said  that  the  best 
pag-e  of  my  record  was  that  in  which  I  had  fought  my 
battle  for  the  poor  poisoned  women.  I  am  reminded 
of  that  essay  from  time  to  time,  but  it  was  published 
in  a  periodical  which  died  after  one  year's  life,  and 
therefore  escaped  the  wider  notice  it  would  have 
found  in  the  American  Journal  of  the  Medical 
Sciences.  A  lecturer  at  one  of  the  great  London 
hospitals  referred  to  it  the  other  day,  and  coupled 
it  with  some  fine  phrases  about  myself  which  made 
me  blush,  either  with  modesty  or  vanity,  I  forget 
which. 

'  I  think  I  will  not  answer  the  question  you  put  me. 
I  think  oftenest  of  the  Chambered  Nautilus^  which 
is  a  favourite  poem  of  mine,  though  I  wrote  it  myself. 
The  essay  only  comes  up  at  long  intervals.  The 
poem  repeats  itself  in  my  memory,  and  is  very 
often  spoken  of  by  my  correspondents  in  terms  of 
more  than  ordinary  praise.  I  had  a  savage  pleasure, 
I  confess,  in  handling  those  two  professors— learned 
men  both  of  them,  skilful  experts,  but  babies,  as 
it  seemed  to  me,  in  their  capacity  of  reasoning  and 
arguing.  But  in  writing  the  poem  I  was  filled  with 
a  better  feeling — the  highest  state  of  mental  exalta- 
tion and  the  most  crystalline  clairvoyance,  as  it 
seemed  to  me,  that  had  ever  been  granted  to  me — 
I  mean  that  lucid  vision  of  one's  thought  and  all 
forms  of  expression  which  will  be  at  once  precise 
and  musical,  which  is  the  poet's  special  gift,  however 
large  or  small  in  amount  or  value.  There  is  more 
selfish  pleasure  to  be  had  out  of  the  poem — perhaps 
a  nobler  satisfaction  from  the  Ufe-saving  labour.'  ^^ 


44 


HISTORY   AND 


Richard 
Lea  Mac- 
Donnell 
{Ob.  1891). 


Very  few  men  have  entered  upon  the  race  with 
greater  advantages  than  did  Dr.  MacDonnell.  To 
a  fine  physique  and  presence,  and  a  charm  of 
manner  which  is  so  often  continued  in  this  country 
in  the  second  generation  of  Irishmen  of  the  Brahmin 
class — to  use  an  expression  of  Oliver  Wendell 
Holmes — there  were  added  those  mental  gifts  which 
alone  assure  success — industry  and  perseverance. 
Very  early  in  his  career  circumstances  in  connexion 
with  the  accidental  death  of  his  father  altered  his 
surroundings  and  threw  upon  him  responsibilities 
that  were  faithfully  and  courageously  met,  and 
that  gave  an  unmistakable  stamp  to  a  character 
naturally  refined  and  noble.  Success  came,  cares 
lightened,  and,  with  domestic,  social,  and  profes- 
sional relations  of  the  happiest  possible  kind,  the 
future  could  not  have  looked  brighter ;  but — es  hat 
nicht  sollen  sein^  and  a  devoted  wife,  an  aged 
mother,  and  a  loving  sister,  with  colleagues,  students, 
and  friends,  mourn  his  untimely  union  with 

'  The  inheritors  of  unfulfilled  renown.'  ^^ 


Palmer 

Howard 

(1823-89) 

an  ideal 
student- 
teacher  ; 


In  my  early  days  I  came  under  the  influence  of  an 
ideal  student-teacher,  the  late  Palmer  Howard,  of 
Montreal.  If  you  ask  what  manner  of  man  he  was, 
I  would  refer  you  to  Matthew  Arnold's  noble 
tribute  to  his  father  in  his  well-known  poem,  Rugby 
Chapel.  When  young,  Dr.  Howard  had  chosen 
a  path — '  path  to  a  clear  purposed  goal ' — and  he 
pursued  it  with  unswerving  devotion.  With  him 
the  study  and  the  teaching  of  medicine  were  an 


BIOGRAPHY  45 

absorbing  passion,  the  ardour  of  which  neither  the 
incessant  and  ever-increasing-  demands  upon  his 
time  nor  the  growing  years  could  quench.  When, 
in  the  summer  of  187 1,  as  a  senior  student,  I  first 
came  into  intimate  contact  with  him,  the  problem 
of  tuberculosis  was  under  discussion,  stirred  up  by 
the  epoch-making  work  of  Villemin  and  the  radical 
views  of  Niemeyer.  Every  lung  lesion  at  the  Mont- 
real General  Hospital  had  to  be  shown  to  him, 
and  I  got  my  first-hand  introduction  to  Laennec, 
to  Andral,  to  Graves,  and  to  Stokes,  and  became 
familiar  with  their  works.  .  .  .  An  ideal  teacher  be- 
cause a  student,  ever  alert  to  the  new  problems,  an  alert  to 
indomitable  energy  enabled  him,  in  the  midst  of  an  pr^jgrns 
exacting  practice,  to  maintain  an  ardent  enthusiasm, 
still  to  keep  bright  the  fires  which  he  had  lighted 
in  his  youth.  Since  those  days  I  have  seen  many 
teachers,  and  I  have  had  many  colleagues,  but  I 
have  never  known  one  in  whom  were  more  happily 
combined  the  stern  sense  of  duty  with  the  mental 
freshness  of  youth.  *^ 

To  one  of  my  teachers  I  must  pay  in  passing  the  James 
tribute  of  filial  affection.  There  are  men  here  P^^^^o  \ 
to-day  who  feel  as  I  do  about  Dr.  James  Bovell — 
that  he  was  of  those  finer  spirits,  not  uncommon 
in  life,  touched  to  finer  issues  only  in  a  suitable 
environment.  Would  the  Paul  of  evolution  have 
been  Thomas  Henry  Huxley  had  the  Senate  elected 
the  young  naturalist  to  a  chair  in  this  University 
(Toronto)  in  1851  }  Only  men  of  a  certain  metal 
rise  superior  to  their  surroundings,  and  while  Dr. 


46  HISTORY   AND 

Bovell  had  that  all- important  combination  of  bound- 
less ambition  with  energy  and  industry,  he  had  that 
fatal  fault  of  difFuseness,  in  which  even  genius  is 
strangled.  With  a  quadrilateral  mind,  which  he 
kept  spinning  like  a  teetotum,  one  side  was  never 
kept  uppermost  for  long  at  a  time.  Caught  in 
a  storm  which  shook  the  scientific  world  with  the 
publication  of  The  Origin  of  Species,  instead  of 
saiHng  before  the  wind,  even  were  it  with  bare 
poles,  he  put  about  and  sought  a  harbour  of  refuge 
in  writing  a  work  on  Natural  Theology,  which  you 
will  find  on  the  shelves  of  second-hand  book-shops 
in  a  company  made  respectable  at  least  by  the 
presence  of  Paley.  He  was  an  omnivorous  reader 
and  transmuter  upon  anything  in  the  science  of  the 
day,  from  protoplasm  to  evolution  ;  but  he  lacked 
concentration  and  that  scientific  accuracy  which  only 
comes  with  a  long  training  (sometimes,  indeed, 
never  comes  !),  and  which  is  the  ballast  of  the  boat. 
But  the  bent  of  his  mind  was  devotional,  and  early 
swept  into  the  Tractarian  movement,  he  became  an 
advanced  Churchman,  a  good  Anglican  Catholic. 
As  he  chaffingly  remarked  one  day  to  his  friend, 
the  Rev.  Mr.  Darling,  he  was  like  the  waterman 
in  Pilgrim's  Progress^  rowing  one  way  towards 
Rome,  but  looking  steadfastly  in  the  other  direction 
towards  Lambeth.  His  Steps  to  the  Altar  and  his 
Lectures  on  the  Advent  attest  the  earnestness  of 
his  convictions ;  and  later  in  life,  following  the 
example  of  Linacre,  he  took  orders,  and  became 
another  illustration  of  what  Cotton  Mather  calls  the 
angelic  conjunction  of  medicine  with  divinity.  ^^ 


BIOGRAPHY  47 

But  what  shall  I  say  of  Leidy,  the  man  In  whom  the  Joseph 

leaven  of  science  wrousfht  with  labour  and  travail  ,  ^    ^     > 

c  :>     on,  V.  ^  •  (1823-91): 

for  so  many  years  ?     1  he  written  record  survives, 

scarcely  equalled   in   variety  and  extent  by  any 

naturalist,  but  how  meagre  is  the  picture  of  the 

man  as  known  to  his  friends.     The  traits  which  patient 

made  his  life  of  such  value — the  patient  spirit,  the  fv^^soosi- 

kindly  disposition,  the  sustained  zeal — we  shall  not  tion,  sus- 

see  again  incarnate.     The  memory  of  them  alone  tamed  zeal; 

remains.     As  the  echoes  of  the  eulogies  upon  his 

life  have  scarcely  died  away,  I  need  not  recount  to 

this  audience  his  ways  and  work,  but  upon  one 

aspect  of  his  character  I  may  dwell  for  a  moment, 

as  illustrating  an  influence  of  science  which  has 

attracted  much  attention  and  aroused  discussion. 

So  far  as  the  facts  of  sense  were  concerned,  there 

was  not  a  trace  of  Pyrrhonism  in  his  composition, 

but  in  all  that  relates  to  the  ultra-rational  no  more 

consistent  disciple  of  the  great  sceptic  ever  lived. 

There  was  in  him,  too,  that  delightful  'ataraxia,'  ataraxia; 

that  imperturbability  which  is  the  distinguishing 

feature  of  the  Pyrrhonist,  in  the  truest  sense  of  the 

word.     A  striking  parallel  exists  between   Leidy  Leidy  and 

and  Darwin  in  this  respect,  and  it  is  an  interesting  ^^^^^win ; 

fact  that  the  two  men  of  this  century  who  have  lived 

in  closest  intercourse  with  nature  should  have  found 

full  satisfaction  in  their  studies  and  in  their  domestic 

affections.     In  the  autobiographical  section  of  the 

Life  of  Charles  Darwin^  edited  by  his  son  Francis, 

in  which  are  laid  bare  with  such  charming  frankness 

the  inner  thoughts  of  the  great  naturalist,  we  find 

that  he  too  had  reached  in  suprasensuous  affairs 


48 


HISTORY   AND 


*  stretching 
the  pia 
mater.' 


that  state  of  mental  imperturbability  in  which,  to 
borrow  the  quaint  expression  of  Sir  Thomas 
Browne,  they  stretched  not  his  pia  mater.  But 
while  acknowledging'  that  in  science  scepticism  is 
advisable,  Darwin  says  that  he  was  not  himself  very 
sceptical.  Of  these  two  men,  alike  in  this  point, 
and  with  minds  distinctly  of  the  Aristotelian  type, 
Darwin  yet  retained  amid  an  overwhelming  ac- 
cumulation of  facts — and  here  was  his  great  supe- 
riority— an  extraordinary  power  of  generalizing 
principles  from  them.  Deficient  as  was  this  quality 
in  Leidy,  he  did  not,  on  the  other  hand,  experience 
*the  curious  and  lamentable  loss  of  the  higher 
aesthetic  taste  '  which  Darwin  mourned,  and  which 
may  have  been  due  in  part  to  protracted  ill-health, 
and  to  an  absolute  necessity  of  devoting  all  his 
powers  to  collecting  facts  in  support  of  his  great 
theory. 

When  I  think  of  Leidy 's  simple  life,  of  his 
devotion  to  the  study  of  Nature,  of  the  closeness  of 
his  communion  with  her  for  so  many  years,  there 
recur  to  my  mind  time  and  again  the  hues : — 

*  He  is  made  one  with  Nature ;  there  is  heard 
His  voice  in  all  her  music,  from  the  moan 

Of  thunder,  to  the  song  of  night's  sweet  bird ; 
He  is  a  presence  to  be  felt  and  known 

In  darkness  and  in  light,  from  herb  and  stone, 
Spreading  itself  where'er  that  Power  may  move 

Which  has  withdrawn  his  being  to  its  own.'"" 


The  early  — i                                                 ... 

American  -T  or  many  years  there  was  m  this  country  a  group 

peripatetic  of  peripatetic  teachers,  who,  like  the  Sophists  of 

teacher.  "      *■                                                                 ^ 


BIOGRAPHY  49 

Greece,  went  from  town  to  town,  staying  a  year  or 
two  in  each,  or  they  divided  their  time  between 
a  winter  session  in  a  large  city  school  and  a  summer 
term  in  a  small  country  one.  Among  them  Daniel 
Drake  takes  the  precedence,  as  he  made  eleven 
moves  in  the  course  of  his  stirring  and  eventful 
life.  Bartlett  comes  an  easy  second,  having  taught 
in  nine  schools.  Dunglison,  T.  R.  Beck,  WiUard 
Parker,  Alonzo  Clark,  the  elder  Gross,  Austin 
Flint,  Frank  H.  Hamilton,  and  many  others  whom 
I  could  name,  belonged  to  this  group  of  wandering 
professors.  The  medical  education  of  the  day  was 
almost  exclusively  theoretical ;  the  teachers  lectured 
for  a  short  four  months'  session,  there  was  a  little 
dissection,  a  few  major  operations  were  witnessed, 
the  fees  were  paid,  examinations  were  held,  and  all 
was  over.  No  wonder,  under  such  conditions,  that 
many  of  the  most  flourishing  schools  were  found 
amid  sylvan  groves  in  small  country  towns.  In 
New  England  there  were  five  such  schools,  and  in 
the  State  of  New  York  the  well-known  schools  of 
Fairfield  and  Geneva.  As  there  was  not  enough 
practice  in  the  small  places  to  go  round,  the  teachers 
for  the  most  part  stayed  only  for  the  session,  at  the 
end  of  which  it  was  not  unusual  for  the  major  part 
of  the  faculty,  with  the  students,  to  migrate  to 
another  institution,  where  the  lectures  were  repeated 
and  the  class  graduated.  ^ 

Compare  the  picture  of  the '  sawbones '  of  1842,  as  The  new 
given  in  the  recent  biography  of  Sir  Henry  Acland,  student, 
with  the  representatives  to-day,  and  it  is  evident 

E 


50  HISTORY   AND   BIOGRAPHY 

a  great  revolution  has  been  effected,  and  very 
largely  by  the  salutary  influences  of  improved 
methods  of  education.  It  is  possible  now  to  fill 
out  a  day  with  practical  work,  varied  enough  to 
prevent  monotony,  and  so  arranged  that  the  know- 
ledge is  picked  out  by  the  student  himself,  and  not 
thrust  into  him  willy-nilly,  at  the  point  of  the 
tongue.  He  exercises  his  wits,  and  is  no  longer 
a  passive  Strasbourg  goose,  tied  up  and  stuffed  to 
repletion.  "* 


PIONEERS  IN  MEDICINE 


OUR  DUTY  TO  BETTER  OUR  TIMES 

In  the  dedication  of  his  Holy  War  Thomas  Fuller  has 
some  very  happy  and  characteristic  remarks  on  the 
bounden  duty  of  a  man  to  better  his  heritage  of  birth 
or  fortune,  and  what  the  father  found  glass  and  made 
crystal,  he  urges  the  son  to  find  crystal  and  make  pearl.  '^ 


E2 


52 


PIONEERS 


Volte-face 

often 
necessary. 


spirit. 


Even  in  well-known  affections,  advances  are  made 
from  time  to  time  that  render  necessary  a  revision 
of  our  accumulated  knowledge,  a  readjustment  of 
old  positions,  a  removal  even  of  old  landmarks. 
Perhaps  the  most  remarkable  illustration  of  this 
is  offered  by  the  discovery  of  a  tubercle  bacillus. 
What  a  volte-face  for  those  of  us  who  were  teachers 
before  1881 !  Happy  those  who  had  ability  and 
wit  sufficient  for  the  summersault!  Scarcely  less 
important  has  been  the  revolution  in  our  knowledge 
of  malaria  since  the  researches  of  Laveran,  in  1881, 
on  the  parasite  of  the  disease.  ^^ 

<^ 
The  pioneer  By  temperament  or  conviction  there  are  a  few  men 
in  every  community  who  cannot  bow  to  the  Baals 
of  the  society  about  them,  and  who  stand  aloof,  in 
thought  at  least,  from  the  common  herd.  Such 
men  in  small  circles  tread  a  steep  and  thorny  road, 
and  of  such  in  all  ages  has  the  race  delighted  to 
make  its  martyrs.  The  letters  indicate  in  Dr.  Bas- 
sett  a  restless,  non-conforming  spirit,  which  turned 
aside  from  the  hollowness  and  deceit  of  the  life 
about  him.  As  a  student  he  had  doubtless  felt 
a  glow  of  enthusiasm  at  the  rapid  development 
of  the  science  of  medicine,  and  amid  the  worries 
and  vexations  of  a  country  practice  his  heart  burned 
with  the  hope  of  some  time  visiting  the  centres  of 
learning.  As  the  years  passed,  the  impulse  grew 
more  and  more  urgent  to  go  forth  and  see  the 
great  minds  which  had  controlled  his  hours  of 
study.  All  students  flocked  to  Paris  in  the  fourth 
decade.  Nowhere  else  was  the  pool  so  deeply  stirred, 


IN    MEDICINE  53 

and  Laennec,  Broussais,  Louis,  Andral,  Velpeau,  and 
others  dominated  the  thoughts  of  the  profession. " 

You  do  well,  citizens  of  St.  Louis  and  members  William 
of  our  profession,  to  cherish  the  memory  of  William  Beaumont 
Beaumont.  Alive  you  honoured  and  rewarded 
him,  and  there  is  no  reproach  against  you  of  merits 
neglected  and  talents  unrecognized.  The  pro- 
fession of  the  northern  part  of  the  State  of  Michigan 
has  honoured  itself  in  erecting  a  monument  to  his 
memory,  near  the  scene  of  his  disinterested  labours 
in  the  cause  of  humanity  and  science.  His  name 
is  linked  with  one  of  your  educational  institutions, 
and  joined  with  that  of  a  distinguished  labourer  in 
another  field  of  practice.  But  he  has  a  far  higher 
honour  than  any  you  can  give  him  here — the 
honour  that  can  only  come  when  the  man  and 
the  opportunity  meet,  and  match.  Beaumont  is 
the  pioneer  physiologist  of  this  country,  the  first 
to  make  an  important  and  enduring  contribution 
to  this  science.  His  work  remains  a  model  of 
patient,  persevering  investigation,  experiment  and 
research,  and  the  highest  praise  we  can  give  him 
is  to  say  that  he  lived  up  to  and  fulfilled  the  ideals 
with  which  he  set  out  and  which  he  expressed 
when  he  said :  '  Truth,  like  beauty,  when  "  un- 
adorned, is  adorned  the  most,"  and,  in  prosecuting 
these  experiments  and  inquiries,  I  believe  I  have 
been  guided  by  its  light.' ' 

The  century  now  drawing  to  a  close  has  seen  the  The 

realization  of  much  that  the  wise  of  old  longed  for,  ni°fteentli 

**  '  century. 


54 


PIONEERS 


Virchow 
(1821-1902) : 
the 
sanitarian. 


much  of  which  the  earnest  spirits  of  the  past  had 
dreamt.  It  has  been  a  century  of  real  progress — a 
time  of  the  loosening  of  bands  and  bonds ;  and  medi- 
cine too,  after  an  enslavement,  ecclesiastical  and 
philosophical,  received  its  emancipation.  Forsaking 
the  traditions  of  the  elders,  and  scouting  the  Shib- 
boleth of  schools  and  sects,  she  has  at  last  put  off 
the  garments  of  her  pride,  and  with  the  reed  of 
humility  in  her  hand  sits  at  the  feet  of  her  mistress, 
the  new  science.  Not  to  any  one  man  can  this 
revolution  be  ascribed :  the  Zeitgeist  was  potent, 
and  like  a  leaven  worked  even  in  unwilling  minds ; 
but  no  physician  of  our  time  has  done  more  to  pro- 
mote the  change,  or  by  his  individual  efforts  to  win 
his  generation  to  accept  it,  than  Rudolf  Virchow.  ^ 

V irchow's  life-work  has  been  the  study  of  the 
processes  of  disease,  and  in  the  profession  we 
revere  him  as  the  greatest  master  that  has  appeared 
since  John  Hunter.  There  is  another  aspect  of  his 
work  which  has  been  memorable  for  good  to  his 
native  city.  From  the  day  when,  as  a  young  man 
of  twenty-seven,  he  was  sent  by  the  Prussian 
Government  to  Upper  Silesia  to  study  the  typhus 
epidemic,  then  raging  among  the  half-starved 
population,  he  has  been  one  of  the  most  powerful 
advocates  in  Germany  for  sanitary  reform ;  and  it 
is  not  too  much  to  say  that  it  is  largely  to  his 
efforts  that  the  city  of  Berlin  owes  its  magnificent 
system  of  drainage.  His  work  in  this  department 
has  been  simply  monumental,  and  characterized  by 
the  thoroughness  which  marks  the  specialist.  ^ 


IN    MEDICINE  55 

Bichat's  Anatomie  generate  laid  the  foundation  Bichat 
of  the  positive  or  modern  method  of  the  study  of  (i77i-i8oa). 
medicine,  in  which  theory  and  reasoning  were 
replaced  by  observation  and  analysis.  Laennec, 
with  the  stethoscope,  and  with  an  accurate  study 
of  disease  at  the  bedside  and  in  the  post-mortem 
room,  almost  created  clinical  medicine  as  we  know 
it  to-day.  ^ 


THE  HUMANITIES  IN  MEDICINE 


QUALITIES  OF  HEART  AND  HEAD 

A  physician  may  possess  the  science  of  Harvey  and  the 
art  of  Sydenham,  and  yet  there  may  be  lacking  in  him 
those  finer  qualities  of  heart  and  head  which  count  for 
so  much  in  life.  ♦ 


58  THE   HUMANITIES 

Breeding        Pasture  is  not  everything,  and  that  indefinable, 
-ggj^j-g^  though  well  understood,  something  which  we  know 

as  breeding  is  not  always  an  accompaniment  of 
great  professional  skill.  Medicine  is  seen  at  its 
best  in  men  whose  faculties  have  had  the  highest 
and  most  harmonious  training.  "* 

<^ 
The  Lathams,  the  Watsons,  the  Pagets,  the 
Jenners,  and  the  Gardiners  have  influenced  the 
profession  less  by  their  special  work  than  by 
exemplifying  those  graces  of  life  and  refinements 
of  heart  which  make  up  a  character.  * 

But  by  the  neglect  of  the  studies  of  the  humani- 
ties, which  has  been  far  too  general,  the  profession 
loses  a  very  precious  quality.'* 

And  the  men  of  this  stamp  in  Greater  Britain 
have  left  the  most  enduring  mark — Beaumont, 
BoveU,  and  Hodder  in  Toronto  ;  Holmes,  Campbell, 
and  Howard  in  Montreal ;  the  Warrens,  the  Jack- 
sons,  the  Bigelows,  the  Bowditches,  and  the  Shat- 
tucks  in  Boston;  Bard,  Hossack,  Francis,  Clark, 
and  Flint  of  New  York ;  Morgan,  Shippen,  Redman, 
Rush,  Coxe,  the  elder  Wood,  the  elder  Pepper,  and 
the  elder  Mitchell  of  Philadelphia — Brahmins  all, 
in  the  language  of  the  greatest  Brahmin  among 
them,  Oliver  Wendell  Holmes :  these  and  men  hke 
unto  them  have  been  the  leaven  which  has  raised 
our  profession  above  the  dead  level  of  a  business.  * 

Biology  Biology  touches  the  problem  of  life  at  every  point, 

and  the  ^^^  jj^y  ^i^im,  as  no  Other  science,  completeness 


IN    MEDICINE  59 

of  view  and  a  comprehensiveness  which  pertains 
to  it  alone.  To  all  whose  daily  work  lies  in  her 
manifestations  the  value  of  a  deep  insight  into  her 
relations  cannot  be  overestimated.  The  study  of 
biology  trains  the  mind  in  accurate  methods  of 
observation  and  correct  methods  of  reasoning,  and 
gives  to  a  man  clearer  points  of  view,  and  an 
attitude  of  mind  more  serviceable  in  the  working- 
day  world  than  that  given  by  other  sciences,  or 
even  by  the  humanities.  ^' 

After  ten  years   of   hard  work  I    left  this  city  Incorrup- 
(Montreal)  a  rich  man,  not  in  this  world's  goods,  ^^uj-ggof 
for  such  I  have  the  misfortune — or  the  good  fortune  the  heart. 
— lightly  to  esteem,  but  rich  in  the  goods  which 
neither  rust  nor  moth  has  been  able  to  corrupt — 
in  treasures  of  friendship  and  good  fellowship,  and 
in  those  treasures  of  widened  experience  and  a 
fuller  knowledge  of  men  and  manners  which  con- 
tact  with   the   bright    minds    in    the    profession 
ensures.  '^ 

But  there  is  a  still  greater  sacrifice  which  many  Culture, 
of  us  make,  heedlessly  and  thoughdessly  forgetting 
that  '  Man  does  not  hve  by  bread  alone.'  One 
cannot  practise  medicine  alone  and  practise  it  early 
and  late,  as  so  many  of  us  have  to  do,  and  hope  to 
escape  the  malign  influences  of  a  routine  life.  The 
incessant  concentration  of  thought  upon  one  subject, 
however  interesting,  tethers  a  man's  mind  in  a 
narrow  field.  The  practitioner  needs  culture  as 
well  as  learning.    The  earliest  picture  we  have  in 


6o  THE    HUMANITIES 

literature  of  a  scientific  physician,  in  our  sense  of 
the  term,  is  of  a  cultured  Greek  gentleman ;  and 
I  care  not  whether  the  young-  man  labours  among 
the  beautiful  homes  on  Sherbrooke  Street,  or  in 
slums  of  Caughnawauga,  or  in  some  sparsely 
settled  country  district,  he  cannot  afford  to  have 
learning  only.  In  no  profession  does  culture  count 
for  so  much  as  in  medicine,  and  no  man  needs  it 
more  than  the  general  practitioner,  working  among 
all  sorts  and  conditions  of  men,  many  of  whom  are 
influenced  quite  as  much  by  his  general  ability, 
which  they  can  appreciate,  as  by  his  learning  of 
which  they  have  no  measure.  The  day  has  passed 
for  the  '  practiser  of  physic  '  to  be  like  Mr.  Robert 
Levet,  Dr.  Johnson's  friend,  'obscurely  wise  and 
coarsely  kind.'  The  wider  and  freer  a  man's 
general  education  the  better  practitioner  is  he 
likely  to  be,  particularly  among  the  higher  classes, 
to  whom  the  reassurance  and  sympathy  of  a  culti- 
vated gentleman  of  the  type  of  Eryximachus  may 
mean  much  more  than  piUs  and  potions.  But 
what  of  the  men  of  the  type  of  Mr.  Robert  Levet, 
or '  Ole  Docteur  Fiset,'  whose  virtues  walk  a  narrow 
round,  the  men  who  do  the  hard  general  practices 
in  the  poorer  districts  of  the  large  cities,  in  the 
factory  towns  and  in  the  widely  scattered  agri- 
cultural regions — what,  I  hear  you  say,  has  culture 
to  do  with  them  ?  Everything !  It  is  the  bichloride 
which  may  prevent  the  infection  and  keep  a  man 
sweet  and  whole  amid  the  most  debasing  surround- 
ings. Of  very  little  direct  value  to  him  in  his 
practice — though  the   poor    have   a   pretty  keen 


IN    MEDICINE  6l 

appreciation  of  a  gentleman — it  may  serve  to  pre- 
vent the  degeneration  so  apt  to  overtake  the 
over-worked  practitioner,  whose  nature  is  only  too 
prone  to  be  subdued  like  the  dyer's  hand  to  what 
it  works  in.  If  a  man  does  not  sell  his  soul ;  if  he 
does  not  part  with  his  birthright  of  independence 
for  a  mess  of  pottage  to  the  Ishmaelites  who  harass 
our  borders  with  their  clubs,  and  oppress  us  with 
their  exactions ;  if  he  can  only  keep  free,  the  con- 
ditions of  practice  are  nowhere  incompatible  with 
St.  Paul's  noble  Christian  or  Aristotle's  true  gentle- 
man. "^    (Sir  Thomas  Browne.) 

Professional  work  of  any  sort  tends  to  narrow  the  The  leaven 
mind,  to  limit  the  point  of  view,  and  to  put  a  hall-  ° 
mark  on  a  man  of  a  most  unmistakable  kind.  On 
the  one  hand  are  the  intense,  ardent  natures, 
absorbed  in  their  studies  and  quickly  losing  interest 
in  everything  but  their  profession,  while  other 
faculties  and  interests  '  fust '  unused.  On  the  other 
hand  are  the  bovine  brethren,  who  think  of  nothing 
but  the  treadmill  and  the  corn.  From  very  dif- 
ferent causes,  the  one  from  concentration,  the  other 
from  apathy,  both  are  apt  to  neglect  those  outside 
studies  that  widen  the  sympathies  and  help  a  man 
to  get  the  best  there  is  out  of  life.  Like  art, 
medicine  is  an  exacting  mistress,  and  in  the  pursuit 
of  one  of  the  scientific  branches,  sometimes  too 
in  practice,  not  a  portion  of  a  man's  spirit  may  be 
left  free  for  other  distractions,  but  this  does  not 
often  happen.  On  account  of  the  intimate  personal 
nature  of  his  work,  the  medical  man,  perhaps  more 


62  THE    HUMANITIES 

than  any  other  man,  needs  that  higher  education 
of  which  Plato  speaks, — '  that  education  in  virtue 
from  youth  upwards,  which  enables  a  man  to 
pursue  the  ideal  perfection.'  It  is  not  for  all,  nor 
can  all  attain  it,  but  there  is  comfort  and  help  in 
the  pursuit,  even  though  the  end  is  never  reached. 
For  a  large  majority  the  daily  round  and  the 
common  task  furnish  more  than  enough  to  satisfy 
their  heart's  desire,  and  there  seems  no  room  left 
for  anjrthing  else.  Like  the  good  easy  man 
whom  Milton  scores  in  the  Areopagitica^  whose 
religion  was  a  'traffic  so  entangled  that  of  all 
mysteries  he  could  not  skill  to  keep  a  stock  going 
upon  that  trade,'  and  handed  it  over  with  all  the 
locks  and  keys  to  '  a  divine  of  note  and  estimation,' 
so  it  is  with  many  of  us  in  the  matter  of  this  higher 
education.  No  longer  intrinsic,  wrought  in  us  and 
engrained,  it  has  become,  in  Milton's  phrase,  a 
'dividual  movable,'  handed  over  nowadays  to  the 
daily  press  or  to  the  haphazard  instruction  of  the 
pulpit,  the  platform,  or  the  magazines.  Like  a  good 
many  other  things,  it  comes  in  a  better  and  more 
enduring  form  if  not  too  consciously  sought.  The 
all-important  thing  is  to  %qX.  a  good  relish  for  the 
good  company  of  the  race  in  a  daily  intercourse 
with  some  of  the  great  minds.  Now,  in  the  spring- 
time of  life,  pick  your  intimates  among  them,  and 
begin  a  systematic  cultivation  of  their  works. 
Many  of  you  will  need  a  strong  leaven  to  raise  you 
above  the  dough  in  which  it  will  be  your  lot  to 
labour.  Uncongenial  surroundings,  an  ever-present 
dissonance  between  the  aspirations  within  and  the 


IN    MEDICINE  63 

actualities  without,  the  oppressive  discords  of  human 
society,  the  bitter  tragedies  of  life,  the  lacrymae 
rerufn^  beside  the  hidden  springs  of  which  we  sit 
in  sad  despair — all  these  tend  to  foster  in  some 
natures  a  cynicism  quite  foreign  to  our  vocation, 
and  to  which  this  inner  education  offers  the  best 
antidote.  Personal  contact  with  men  of  high  pur- 
pose and  character  will  help  a  man  to  make  a 
start — to  have  the  desire,  at  least ;  but  in  its  fullness 
this  culture — for  that  word  best  expresses  it — has 
to  be  wrought  out  by  each  one  for  himself.  Start 
at  once  a  bedside  library  and  spend  the  last  half- 
hour  of  the  day  in  communion  with  the  saints  of 
humanity.  There  are  great  lessons  to  be  learned 
from  Job  and  from  David,  from  Isaiah  and  St.  Paul. 
Taught  by  Shakespeare  you  may  take  your  in- 
tellectual and  moral  measure  with  singular  precision. 
Learn  to  love  Epictetus  and  Marcus  Aurelius. 
Should  you  be  so  fortunate  as  to  be  born  a  Pla- 
tonist,  Jowett  will  introduce  you  to  the  great 
master  through  whom  alone  we  can  think  in  certain 
levels,  and  whose  perpetual  modernness  startles  and 
delights.  Montaigne  will  teach  you  moderation 
in  all  things,  and  to  be  '  sealed  of  his  tribe '  is  a 
special  privilege.  We  have  in  the  profession  only 
a  few  great  literary  heroes  of  the  first  rank,  the 
friendship  and  counsel  of  two  of  whom  you  cannot 
too  earnestly  seek.  Sir  Thomas  Browne's  Reltgio 
Medici  should  be  your  pocket  companion,  while 
from  the  Breakfast  Table  Series  of  Oliver  Wendell 
Holmes  you  can  glean  a  philosophy  of  life 
peculiarly  suited   to   the  needs    of  a  physician. 


64  THE    HUMANITIES    IN    MEDICINE 

There  are  at  least  a  dozen  or  more  works  which 
would  be  helpful  in  getting  wisdom  in  life  which 
comes  only  to  those  who  earnestly  seek  it.  '* 

The  The  physician  needs  a  clear   head  and  a  kind 

^  T'ti^^^  £     heart ;  his  work  is  arduous  and  complex,  requiring 

the  exercise  of  the  very  highest  faculties  of  the 

mind,  while  constantly  appealing  to  the  emotions 

and  finer  feelings.  '^ 


THE  PRACTICAL  IN  MEDICINE 


THE  PRACTICAL  ANGLO-SAXON 

Thucydides  it  was  who  said  of  the  Greeks  that  they 
possessed  'the  power  of  thinking  before  they  acted,  and 
of  acting,  too.'  The  same  is  true  in  a  high  degree  of  the 
English  race.  To  know  just  what  has  to  be  done,  then 
to  do  it,  comprises  the  whole  philosophy  of  practical 
life." 


66 


THE    PRACTICAL 


The 

practical 
Anglo- 
Saxon. 


Wisdom. 


The  high 
mission  of 
the 
physician. 


Bichat,  Laennec,  and  Louis  laid  the  foundation  of 
modern  clinical  medicine ;  Virchow  and  his  pupils 
of  scientific  pathology ;  while  Pasteur  and  Koch 
have  revolutionized  the  study  of  the  causes  of  dis- 
ease; and  yet,  the  modern  history  of  the  art  of 
medicine  could  almost  be  written  in  its  fullness  from 
the  records  of  the  Anglo-Saxon  race.  We  can 
claim  every  practical  advance  of  the  very  first  rank 
— vaccination,  anaesthesia,  preventive  medicine,  and 
antiseptic  surgery,  the  '  captain  jewels  in  the  car- 
canet '  of  the  profession,  beside  which  can  be  placed 
no  others  of  equal  lustre.  ^ 

And  finally  every  medical  student  should  remember 
that  his  end  is  not  to  be  made  a  chemist  or  physio- 
logist or  anatomist,  but  to  learn  how  to  recognize 
and  treat  disease,  how  to  become  a  practical  phy- 
sician. Twenty  years  ago,  during  the  summer 
session,  I  held  my  first  class  in  clinical  medicine  at 
the  Montreal  General  Hospital,  and  on  the  title- 
page  of  a  notebook  I  had  printed  for  the  students 
I  placed  the  following  sentence,  which  you  will  find 
the  alpha  and  omega  of  practical  medicine,  not  that 
it  by  any  means  covers  the  whole  field  of  his  educa- 
tion : — 

'  The  knowledge  which  a  man  can  use  is  the  only 
real  knowledge,  the  only  knowledge  which  has  life 
and  growth  in  it,  converts  itself  into  practical  power. 
The  rest  hangs  like  dust  about  the  brain  or  dries 
like  rain-drops  off  the  stones.'     (Froude.)  '^ 

'Tis  no  idle  challenge  which  we  physicians  throw 
out  to  the  world  when  we  claim  that  our  mission  is 


IN    MEDICINE  67 

of  the  highest  and  of  the  noblest  kind,  not  alone 
in  curing  disease  but  in  educating  the  people  in 
the  laws  of  health,  and  in  preventing  the  spread  of 
plagues  and  pestilences,  nor  can  it  be  gainsaid  that 
of  late  years  our  record  as  a  body  has  been  more 
encouraging  in  its  practical  results  than  those  of 
the  other  learned  professions.  ^^ 

But  take  the  other  view  of  it — think  of  the  Nemesis  Pain. 
which  has  overtaken  pain  during  the  past  fifty 
years!  Anaesthetics  and  antiseptic  surgery  have 
almost  manacled  the  demon,  and  since  their  intro- 
duction the  aggregate  of  pain  which  has  been 
prevented  far  outweighs  in  civilized  communities 
that  which  has  been  suffered.  Even  the  curse  of 
travail  has  been  lifted  from  the  soul  of  women.  ^^ 

The  processes  of  disease  are  so  complex  that  it  is  The  new 
excessively  difiicult  to  search  out  the  laws  which  s^°ol- 
control  them,  and,  although  we  have  seen  a  com- 
plete revolution  in  our  ideas,  what  has  been  accom- 
plished by  the  new  school  of  medicine  is  only  an 
earnest  of  what  the  future  has  in  store.  ^^ 

The  student  must  be  allowed  full  freedom  in  his  Cui  bono  ? 
work,  undisturbed  by  the  utilitarian  spirit  of  the 
Philistine,  who  cries,  Cui  bono  ?  and  distrusts  pure 
science.  The  present  remarkable  position  in  applied 
science  and  in  industrial  trades  of  all  sorts  has  been 
made  possible  by  men  who  did  pioneer  work  in 
chemistry,  in  physics,  in  biology,  and  in  physiology, 
F2 


68  THE    PRACTICAL    IN    MEDICINE 

without  a  thought  in  their  researches  of  any  prac- 
tical application.  The  members  of  this  higher 
group  of  productive  students  are  rarely  understood 
by  the  common  spirits,  who  appreciate  as  little 
their  unselfish  devotion  as  their  unworldly  neglect 
of  the  practical  side  of  the  problems.  *^ 


CATHOLICITY  IN  MEDICINE 


THE  CURSED  SPIRIT  OF  INTOLERANCE 

Breathes  here  a  man  with  soul  so  dead  that  it  does  not 
glow  at  the  thought  of  what  the  men  of  his  blood  have 
done  and  suffered  to  make  his  country  what  it  is  ?  There 
is  room,  plenty  of  room,  for  proper  pride  of  land  and 
birth.  What  I  inveigh  against  is  a  cursed  spirit  of 
intolerance,  conceived  in  distrust  and  bred  in  ignorance, 
that  makes  the  mental  attitude  perennially  antagonistic, 
even  bitterly  antagonistic,  to  everything  foreign,  that 
subordinates  everywhere  the  race  to  the  nation,  forgetting 
the  higher  claims  of  human  brotherhood.  '^ 


70 


CATHOLICITY 


Need  of  the 

Wander' 

Jahre. 


Chauvinism.  At  any  rate,  whether  he  goes  abroad  or  not,  let 
him  early  escape  from  the  besetting  sin  of  the 
young  physician,  chauvinism,  that  intolerant  atti- 
tude of  mind  which  brooks  no  regard  for  anything 
outside  his  own  circle  and  his  own  school.  ^ 

R)St-gTaduate  study  is  needed  In  all  classes  among 
us.  The  school  for  the  young  practitioner  is  a 
general  practice  in  which  the  number  and  variety 
of  cases  will  enable  him  at  once  to  put  his  methods 
into  daily  use.  A  serious  defect  may  warp  his 
course  from  the  outset.  Our  students  study  too 
much  under  one  set  of  teachers.  In  English  and 
American  schools  they  do  not  move  about  enough. 
At  a  tender  age,  four  or  five  years  give  a  man 
a  local  attachment  to  place  and  teachers  which  is 
very  natural,  very  nice,  but  not  always  the  best 
thing  for  him.  He  goes  out  with  a  strong  bias 
already  in  his  mind,  and  is  ready  to  cry,  '  I  am  of 
Guy's,' '  I  am  of  Bart.'s,'  or  '  I  am  an  Edinburgh 
man.'  To  escape  from  these  local  trammels,  which 
may  badly  handicap  a  man  by  giving  him  an  arro- 
gant sense  of  superiority  often  most  manifest  when 
there  is  least  warrant,  is  very  difficult.  I  knew 
three  brothers,  Edinburgh  men,  good  fellows  at 
heart  and  good  practitioners,  but  for  them  the 
science  and  art  of  medicine  never  extended  beyond 
what  their  old  teachers  had  taught.  A  Guy's  man 
they  could  just  endure,  for  the  sake,  as  one  of  them 
said,  of  Bright,  and  Cooper,  and  Addison,  but  for 
men  of  other  schools  they  entertained  a  supreme 
and  really  ludicrous  contempt. ' 


IN   MEDICINE  71 

Can  we    say,  as    English,  French,   German,  or  The  curse  of 

American  physicians,  that  our  culture  is  always  nationahsm. 

cosmopolitan,  not  national,  that  our  attitude   of 

mind  is  always  as  frankly  open  and  friendly  to  the 

French  as  to  the  English,  to  the  American  as  to 

the  German,  and  that  we  are  free  at  all  times  and 

in  all  places  from  prejudice,  at  all  times  free  from 

a  self-satisfied  feeling  of  superiority,  the  one  over 

the  other  ?     There  has  been  of  late  years  a  closer 

union  of  the  profession  of  the  different  countries 

through  the  International  Congress  and  through 

the  international  meetings  of  the  special  societies ; 

but  this  is  not  enough,  and  the  hostile  attitude  has 

by  no  means  disappeared.     Ignorance  is  at  the  root. 

When  a  man  talks  slightingly  of  the  position  and 

work  of  his  profession  in  any  country,  or  when 

a  teacher  tells  you  that  he  fails  to  find  inspiration 

in  the  work  of  his  foreign  colleagues,  in  the  words 

of  the  Arabian  proverb — he  is  a  fool,  shun  him. 

Full  knowledge  which  alone  disperses  the  mists  of 

ignorance,  can  only  be  obtained  by  travel  or  by 

a  thorough  acquaintance  with  the  literature  of  the 

different  countries.     Personal,  first-hand  intercourse 

with  men  of  different  lands,  when  the  mind  is  young 

and  plastic,  is  the  best  vaccination  against  disease. 

The  man  who  has  sat  at  the  feet  of  Virchow,  or 

has  listened"  to  Traube,  or  Helmholtz,  or  Cohnheim, 

can  never  look  with  unfriendly  eyes  at  German 

medicine  or  German   methods.     Who   ever  met 

with  an  English  or  American  pupil  of  Louis  or  of 

Charcot,  who  did  not  love  French  medicine,  if  not 

for  its  own  sake,  at  least  for  the  reverence  he  bore 


72  CATHOLICITY 

his  great  master  ?  Let  our  young  men,  particularly 
those  who  aspire  to  teaching  positions,  go  abroad. 
They  can  find  at  home  laboratories  and  hospitals 
as  well  equipped  as  any  in  the  world,  but  they  may 
find  abroad  more  than  they  knew  they  sought — 
widened  sympathies,  heightened  ideals,  and  some- 
thing perhaps  of  a  Weltcultur  which  will  remain 
through  life  as  the  best  protection  against  the  vice 
of  nationalism.  ^^ 

If  the  life  and  work  of  such  men  as  Bichat  and 
Laennec  will  not  stir  the  blood  of  a  young  man  and 
make  him  feel  proud  of  France  and  of  Frenchmen, 
he  must  be  a  dull  and  muddly-mettled  rascal.  In 
reading  the  life  of  Hunter,  of  Jenner,  who  thinks  of 
the  nationality  which  is  merged  and  lost  in  our 
interest  in  the  man  and  in  his  work?  In  the 
halcyon  days  of  the  Renaissance  there  was  no 
nationahsm  in  medicine,  but  a  fine  catholic  spirit 
made  great  leaders  like  Vesalius,  Eustachius,  Sten- 
sen,  and  others  at  home  in  every  country  in  Europe. 
While  this  is  impossible  to-day,  a  great  teacher  of 
any  country  may  have  a  world-wide  audience  in 
our  journal  literature,  which  has  done  so  much  to 
make  medicine  cosmopolitan.  ^^ 

Democracy     Shun  as  most  pernicious  that  frame  of  mind,  too 
in  medicine,    often,  I  fear,  seen  in  physicians,  which  assumes  an 
air  of  superiority  and  limits  as  worthy  of  your  com- 
munion only  those  with  satisfactory  collegiate  or 
sartorial  credentials.  ^^ 


IN    MEDICINE  73 

The  passports  to  your  fellowship  should  be 
honesty  of  purpose  and  a  devotion  to  the  highest 
interest  of  your  profession,  and  these  you  will  find 
widely  diffused,  sometimes  apparent  only  when  you 
get  beneath  the  crust  of  a  rough  exterior.  '''* 

By  his  commission  the  physician  is  sent  to  the  Thecosmo- 

sick,  and  knowing  in  his  calling  neither  Jew  nor  politan 

Gentile,  bond  or    free,  perhaps   he    alone    rises  of  the 

superior  to  those  differences  which  separate  and  physician. 

make  us  dwell  apart,  too  often  oblivious  to  the 

common  hopes  and  frailties  which  should  bind  us 

together  as  a  race.     In  his  professional  relations, 

though  divided  by  national  lines,  there  remains  the 

feeling  that  he  belongs  to  a  guild  which  owes  no 

local  allegiance,  which  has  neither  king  nor  country, 

but  whose  work  is  in  the  world.     The  Aesculapian 

temple  has  given  place  to  the  hospital,  and  the 

priestly  character  of  the  physician  has  vanished 

with  the  ages ;  still,  there  is  left  with  us  a  strong 

feeling  of  brotherhood,  a  sense  of  unity,  which  the 

limitations  of  language,  race,  and  country  have  not 

been  able  to  efface.      So  it  has  seemed  meet  and 

right  to  gather  here  this  evening  to  do  honour  to 

a  man — not  of  this  country,  nor  of  our  blood — 

whose  life  has  been  spent  in  the  highest  interests  of 

humanity,  whose  special  work  has  revolutionized 

the  science  of  medicine,  whose  genius  has  shed 

lustre  upon  our  craft.  * 

Another  unpleasant  manifestation  of  collegiate  chau-  The  *  lock 
vinism  is  the  outcome,  perhaps,  of  the  very  keen  com-  ^bor^»rv 


74  CATHOLICITY 

petition  which  at  present  exists  in  scientific  circles. 
Instead  of  a  generous  appreciation  of  the  work  done 
in  other  places,  there  is  a  settled  hostility  and  a 
narrowness  of  judgement  but  little  in  keeping  with 
the  true  spirit  of  science.  Worse  still  is  the  '  lock 
and  key  '  laboratory  in  which  suspicion  and  distrust 
reign,  and  every  one  is  jealous  and  fearful  lest  the 
other  should  know  of  or  find  out  about  his  work. 
Thank  God!  this  base  and  bastard  spirit  is  not 
much  seen ;  but  it  is  about,  and  I  would  earnestly 
advise  any  young  man  who  unwittingly  finds  him- 
self in  a  laboratory  pervaded  with  this  atmosphere, 
to  get  out  ere  the  contagion  sinks  into  his  soul.  ^^ 

Science  and    It  is  well  to  acknowledge  the  debt  which  we  every- 
practice.  ^^^  practitioners  owe  to   the   great  leaders  and 

workers  in  the  scientific  branches  of  our  art.  We 
dwell  too  much  in  corners,  and,  consumed  with  the 
petty  cares  of  a  bread-and-butter  struggle,  forget 
that  outside  our  routine  lie  Elysian  fields  into 
which  we  may  never  have  wandered,  the  tillage  of 
which  is  not  done  by  our  hands,  but  the  fruits  of 
which  we  of  the  profession  (and  you  of  the  public) 
fully  and  freely  enjoy.  The  lesson  which  should 
sink  deepest  into  our  hearts  is  the  answer  which 
a  life  such  as  Virchow's  gives  to  those  who  to-day, 
as  in  past  generations,  see  only  pills  and  potions 
in  the  profession  of  medicine,  and  who,  utilizing 
the  gains  of  science,  fail  to  appreciate  the  dignity 
and  the  worth  of  the  methods  by  which  they  are 
attained.     As  Pausanias  pestered  Empedocles,  even 


IN    MEDICINE  75 

to  the  end,  for  the  details  of  the  cure  of  Pantheia, 
so  there  are  with  us  still  those  who,  *  asking  not 
wisdom,  but  drugs  to  charm  with,'  are  impatient  at 
the  slow  progress  of  science,  forgetting  that  the 
chaos  from  which  order  is  now  appearing  has  been 
in  great  part  dispelled  by  the  work  of  one  still 
living — by  the  man  whom  to-night  we  delight  to 
honour.  ^ 


HONESTY,  TRUTH,  ACCURACY,  AND 
THOROUGHNESS  IN  MEDICINE 


THE  ARTISTIC  SENSE  OF  PERFECTION 

Tbe  artistic  sense  of  perfection  in  work  is  another 
much-to-be-desired  quality  to  be  cultivated.  No  matter 
how  trifling  the  matter  on  hand,  do  it  with  a  feeling  that 
it  demands  the  best  that  is  in  you,  and  when  done  look  it 
over  with  a  critical  eye,  not  sparing  a  strict  judgement  of 
yourself.  This  it  is  that  makes  anatomy  a  student's 
touchstone.  Take  the  man  who  does  his  •  part '  to  per- 
fection, who  has  got  out  all  there  is  in  it,  who  labours  over 
the  tags  of  connective  tissue,  and  who  demonstrated 
Meckel's  ganglion  in  his  part— this  is  the  fellow  in  after 
years  who  is  apt  in  emergencies,  who  saves  a  leg  badly 
smashed  in  a  railway  accident,  or  fights  out  to  the  finish, 
never  knowning  when  he  is  beaten,  in  a  case  of  typhoid 
fever.  '* 


78      HONESTY,    TRUTH,    ACCURACY,    AND 

Nature  and  If  we  have  now  so  far  outgrown  this  idea  as  to 
hesitate  to  suggest,  in  seasons  of  epidemic  peril, 
that '  it  is  for  our  sins  we  suffer  ' — when  we  know 
the  drainage  is  bad ;  if  we  no  longer  mock  the 
heart  prostrate  in  the  grief  of  loss  with  the  words 
'  whom  the  Lord  loveth  He  chasteneth ' — when  we 
know  the  milk  should  have  been  sterilized — if, 
I  say,  we  have,  in  a  measure,  become  emancipated 
from  such  teachings,  we  have  not  yet  risen  to  a  true 
conception  of  nature.  '* 

Credo  of  a  Rarely  has  the  credo  of  a  zealous  physician  been 
more  beautifully  expressed  than  in  the  following 
words  of  Dr.  Bassett : — 

'  I  do  not  say  that  the  study  of  nature,  human 
and  comparative,  as  far  as  it  relates  to  medicine,  is 
an  easy  task  ;  let  any  one  undertake  a  foreign 
language,  and  when  he  thinks  he  has  mastered  it, 
let  him  go  into  its  native  country  and  attempt  to 
use  it  among  the  polite  and  well  informed ;  if  he 
succeed,  let  him  go  among  the  illiterate  and  rude, 
where  slang  is  current ;  into  the  lunatic  asylum, 
where  the  vernacular  is  babbled  in  broken  sentences 
through  the  mouth  of  an  idiot,  and  attempt  to 
understand  this ;  should  he  again  succeed  he  may 
safely  say  that  he  knows  the  language.  Let  him 
then  set  down  and  calculate  the  cost,  in  labour, 
time,  and  talent ;  then  square  this  amount  and  go 
boldly  into  the  study  of  physiology ;  and  when  he 
has  exhausted  his  programme,  he  will  find  himself 
humbly  knocking  at  the  door  of  the  temple,  and  it 
will  be  opened ;  for  diligence,  like  the  vinegar  of 
Hannibal,  will  make  a  way  through  frozen  Alps ;  it 
is  the  "  Open  Sesame  "  of  our  profession.  When 
he  is  satisfied  with  the  beautiful  portions  of  the 


THOROUGHNESS    IN    MEDICINE  79 

interior,  its  vast  and  varied  dimensions,  the  intricate 
and  astounding  action  of  its  machinery,  obeying 
laws  of  a  singular  stability,  whose  very  conflict 
produces  harmony  under  the  government  of 
secondary  laws,  if  there  be  anything  secondary  in 
nature! — when  he  is  satisfied  (and  such  are  not 
satisfied  until  informed),  he  will  be  led  to  his  ulti- 
mate object,  to  take  his  last  lessons  from  the  poor 
and  suffering,  the  fevered  and  phrenzied,  from  the 
Jobs  and  Lazaruses, — into  the  pest-houses  and 
prisons,  and  here,  in  the  magazines  of  misery  and 
contagion,  these  Babels  of  disease  and  sin,  he  must 
not  only  take  up  his  abode,  but  following  the 
example  of  his  Divine  Master,  he  must  love  to 
dwell  there ; — this  is  Pathology.  When  such  an  one 
re-enters  the  world  he  is  a  physician  ;  his  vast 
labours  have  not  only  taught  him  how  little  he 
knows,  but  that  he  knows  his  litde  well.  Con- 
scious of  this  virtue,  he  feels  no  necessity  of 
trumpeting  his  professional  acquirements  abroad, 
but  with  becoming  modesty  and  true  dignity,  which 
constitutes  genuine  professional  pride,  he  leaves 
this  to  the  good  sense  of  his  fellow  citizens  to 
discover.' " 


You  remember,  in  the  Egyptian  story,  how  Typhon  Fragments 
with  his  conspirators  dealt  with  good  Osiris ;  how  °^  trutl*- 
they  took  the  virgin  Truth,  hewed  her  lovely  body 
into  a  thousand  pieces,  and  scattered  them  to  the 
four  winds ;  and,  as  Milton  says,  '  from  that  time 
ever  since,  the  sad  friends  of  truth,  such  as  durst 
appear,  imitating  the  careful  search  that  Isis  made 
for  the  mangled  body  of  Osiris,  went  up  and  down 
gathering  up  limb  by  limb  still  as  they  could  find 
them.     We  have  not  yet  found  them  all,'  but  each 


8o       HONESTY,    TRUTH;   ACCURACY,    AND 


of  US  may  pick  up  a  fragment,  perhaps  two,  and  in 
moments  when  mortality  weighs  less  heavily  upon 
the  spirit,  we  can,  as  in  a  vision,  see  the  form  divine, 
just  as  a  great  naturalist,  an  Owen  or  a  Leidy,  can 
reconstruct  an  ideal  creature  from  a  fossil  frag- 
ment. =^ 

The  1o  the  physician  particularly  a  scientific  discipline 

discipline  of  jg  an  incalculable  g^ft,  which  leavens  his  whole  life, 
giving  exactness  to  habits  of  thought  and  tempering 
the  mind  with  that  judicious  faculty  of  distrust  which 
can  alone,  amid  the  uncertainties  of  practice,  make 
him  wise  unto  salvation.  For  perdition  inevitable 
awaits  the  mind  of  the  practitioner  who  has  nevef 
had  the  full  inoculation  with  the  leaven,  who  has 
never  grasped  clearly  the  relations  of  science  to 
his  art,  and  who  knows  nothing  and  perhaps  cares 
less  for  the  limitations  of  either. " 

It  cannot  be  denied  that  in  dealings  with  the  public 
just  a  little  touch  of  humbug  is  immensely  effective, 
but  it  is  not  necessary. 

In  a  large  city  there  were  three  eminent  con- 
sultants of  world-wide  reputation  ;  one  was  said  to 
be  a  good  physician  but  no  humbug,  the  second 
was  no  physician  but  a  great  humbug,  the  third 
was  a  great  physician  and  a  great  humbug.  The 
first  achieved  the  greatest  success,  professional  and 
social,  possibly  not  financial.  ^ 

Start  out  with  the  conviction  that  absolute  truth 
is  hard  to  reach  in  matters  relating  to  our  fellow 


Humbug. 


Truth  hard 
to  reach. 


THOROUGHNESS    IN    MEDICINE  8l 

creatures,  healthy  or  diseased,  that  sh'ps  in  observa- 
tion are  inevitable  even  w^ith  the  best  trained 
faculties,  that  errors  in  judgement  must  occur  in 
the  practice  of  an  art  which  consists  largely  in 
balancing  probabilities ; — start,  I  say,  w^ith  this 
attitude  of  mind,  and  mistakes  w^ill  be  acknow- 
ledged and  regretted ;  but  instead  of  a  slow  pro- 
cess of  self-deception,  with  ever-increasing  inability 
to  recognize  truth,  you  will  draw  from  your  errors 
the  very  lessons  which  may  enable  you  to  avoid 
their  repetition.  '^ 

And,  for  the  sake  of  what  it  brings,  the  grace  of  Humility, 
humility  is  a  precious  gift.  When  to  the  sessions 
of  sweet  silent  thought  you  summon  up  the  re- 
membrance of  your  own  imperfections,  the  faults  of 
your  brothers  will  seem  less  grievous,  and,  in  the 
quaint  language  of  Sir  Thomas  Browne,  you  will 
'  allow  one  eye  for  what  is  laudable  in  them.'  ^^ 

The  wrangling  and  unseemly  disputes  which 
have  too  often  disgraced  our  profession  arise,  in  a 
great  majority  of  cases,  on  the  one  hand,  from  this 
morbid  sensitiveness  to  the  confession  of  error,  and, 
on  the  other,  from  a  lack  of  brotherly  consideration, 
and  a  convenient  forgetfulness  of  our  own  failings.'' 

A  man  cannot  become  a  competent  surgeon  with-  The  sciences 
out    a    full    knowledge   of  human    anatomy  and  essential, 
physiology,  and  the  physician  without  physiology 
and  chemistry  flounders  along  in  an  aimless  fashion, 
never  able  to  gain    any  accurate  conception  of 

G 


82     HONESTY,    TRUTH,    ACCURACY,    AND 

disease,  practising  a  sort  of  popgun  pharmacy, 
hitting  now  the  malady  and  again  the  patient,  he 
himself  not  knowing  which.  ^^ 

<? 
Humility.  The  art  of  detachment,  the  virtue  of  method,  and 
the  quality  of  thoroughness  may  make  you  students, 
in  the  true  sense  of  the  word,  successful  prac- 
titioners, or  even  great  investigators,  but  your 
characters  may  still  lack  that  which  can  alone  give 
permanence  to  powers — the  grace  of  humihty.  ^^ 

As  the  divine  Italian,  at  the  very  entrance  to 
Purgatory,  was  led  by  his  gentle  master  to  the 
banks  of  the  island  and  girt  with  a  rush,  indicating 
thereby  that  he  had  cast  off  all  pride  and  self- 
conceit,  and  was  prepared  for  his  perilous  ascent 
to  the  realms  above,  so  should  you,  now  at  the 
outset  of  your  journey,  take  the  reed  of  humility  in 
your  hands,  in  token  that  you  appreciate  the  length 
of  the  way,  the  difficulties  to  be  overcome,  and  the 
fallibility  of  the  faculties  upon  which  you  depend.  ^^ 

In  these  days  of  aggressive  self-assertion,  when 
the  stress  of  competition  is  so  keen  and  the  desire 
to  make  the  most  of  oneself  so  universal,  it  may 
seem  a  little  old-fashioned  to  preach  the  necessity 
of  this  virtue,  but  I  insist  for  its  own  sake,  and  for 
the  sake  of  what  it  brings,  that  a  due  humility 
should  take  the  place  of  honour  on  the  list.  ^^ 

Reverence  v 

for  truth  the   Ibr  its  own  sake,  since  with  it  (humility)  comes 

h^ailt  •         ^°^  ^^^y  ^  reverence  for  truth,  but  also  a  proper 


THOROUGHNESS    IN    MEDICINE  83 

estimation  of  the  difficulties  encountered  in  our 
search  for  it.  ^^ 

At  the  outset  do  not  be  worried  about  this  big-  Truth. 
subject — Truth.  It  is  a  very  simple  matter  if  each 
one  of  you  starts  with  the  desire  to  get  as  much  as 
possible.  No  human  being  is  constituted  to  know 
the  truth,  the  whole  truth,  and  nothing  but  the 
truth ;  and  even  the  best  of  men  must  be  content 
with  fragments,  with  partial  glimpses,  never  the 
full  fruition.  In  this  unsatisiSed  quest  the  attitude 
of  mind,  the  desire,  the  thirst  (a  thirst  that  from 
the  soul  must  rise!),  the  fervent  longing  are  the 
be-all  and  the  end-all. '^^ 

What  is  the  student  but  a  lover  courting  a  fickle  Truth: 
mistress  who  ever  eludes  his  grasp }  In  this  very  ^^'  **  *^* 
elusiveness  is  brought  out  his  second  great  charac- 
teristic— steadfastness  of  purpose.  Unless  from  the 
start  the  limitations  incident  to  our  frail  human 
faculties  are  frankly  accepted,  nothing  but  disap- 
pointment awaits  you.  The  truth  is  the  best  you 
can  get  with  your  best  endeavour,  the  best  that  the 
best  men  accept — with  this  you  may  soon  learn 
to  be  satisfied,  at  the  same  time  retaining  a  due 
humility  and  an  earnest  desire  for  an  ever  larger 
portion.  *^ 

Only  by  keeping  the  mind  plastic  and  receptive  Notrecog- 
does  the  student  escape  perdition.     It  is  not,  as  sizing  the 
Charles  Lamb  remarks,  that  some  people  do  not  «mind^ 
know  what  to  do  with  truth  when  it  is  offered  to  blindness.' 
G  2 


84      HONESTY,    TRUTH,    ACCURACY,   AND 

them,  but  the  tragic  fate  is  to  reach,  after  years 
of  patient  search,  a  condition  of  mind-blindness, 
in  which  the  truth  is  not  recognized,  though  it 
stares  you  in  the  face.  This  can  never  happen  to 
a  man  who  has  followed  step  by  step  the  growth 
of  a  truth,  and  who  knows  the  painful  phases  of 
its  evolution.  It  is  one  of  the  great  tragedies 
of  life  that  every  truth  has  to  struggle  to  accep- 
tance against  honest  but  mind -blind  students. 
Harvey  knew  his  contemporaries  well,  and  for 
twelve  successive  years  demonstrated  the  circu- 
lation of  the  blood  before  daring  to  publish  the 
facts  on  which  the  truth  was  based.  Only  stead- 
fastness of  purpose  and  humility  enable  the  student 
to  shift  his  position  to  meet  the  new  conditions  in 
which  new  truths  are  born.  *^ 

Professional    More  perhaps  than  any  other  professional  man,  the 

sensitive-        doctor  has  a  curious — shall  I  say  morbid  ? — sensi- 
ness. 

tiveness  to  (what  he  regards)  personal  error.     In 

a  way  this  is  right ;  but  it  is  too  often  accompanied 

by  a  cocksureness  of  opinion  which,  if  encouraged, 

leads   him   to  so  lively  a  conceit  that  the  mere 

suggestion  of  mistake  under  any  circumstances  is 

regarded  as  a  reflection  on  his  honour,  a  reflection 

equally  resented  whether  of  lay  or  professional 

origin.  ^^  ^ 

Thorough-      And    thirdly,  add  to  the  virtue  of  method  the 
^^^^  quality  of  thoroughness^  an  element  of  such  im- 

portance that  I  had  thought  of  making  it  the  only 
subject  of  my  remarks.  ^^ 


THOROUGHNESS   IN    MEDICINE  85 

Let  me  tell  you  briefly  what  it  means.  A  know- 
ledge of  the  fundamental  sciences  upon  which  our 
art  is  based — chemistry,  anatomy,  and  physiology — 
not  a  smattering,  but  a  full  and  deep  acquaintance, 
not  with  all  the  facts — that  is  impossible — but  with, 
the  great  principles  based  upon  them.  ^"^ 

You  cannot  of  course  in  the  brief  years  of 
pupilage  so  grasp  the  details  of  the  various  branches 
that  you  can  surely  recognize  and  successfully  treat 
all  cases.  But  here,  if  you  mastered  certain  prin- 
ciples, is  at  any  rate  one  benefit  of  thoroughness — 
you  will  avoid  the  sloughs  of  charlatanism.  ^^ 

You  should,  as  students,  become  familiar  with 
the  methods  by  which  advances  in  knowledge  are 
made,  and  in  the  laboratory  see  clearly  the  paths 
the  great  masters  have  trodden,  though  you  your- 
selves cannot  walk  therein.  ^^ 

The  higher  the  standard  of  education  in  a  pro-  Charlatan- 
fession  the  less  marked  will  be  the  charlatanism,  *^™- 
whereas  no  greater  incentive  to  its  development 
can  be  found  than  in  sending  out  from  our  colleges 
men  who  have  not  had  mental  training  sufficient  to 
enable  them  to  judge  between  the  excellent  and 
the  inferior,  the  sound  and  the  unsound,  the  true 
and  the  half  true.  ^"^ 

A  rare  and  precious  gift  is  the  art  of  detachment.  The  art  of 
by  which  a  man  may  so  separate  himself  from  a  life- 


detachment. 


detachment. 


86     HONESTY,    TRUTH,   ACCURACY,    AND 

long  environment,  as  to  take  a  panoramic  view  of 
the  conditions  under  which  he  has  Hved  and  moved ; 
it  frees  him  from  Plato's  den  long  enough  to  see 
the  realities  as  they  are,  the  shadows  as  they  appear. 
Could  a  physician  attain  to  such  an  art,  he  would 
find  in  the  state  of  his  profession  a  theme  calling 
as  well  for  the  exercise  of  the  highest  faculties  of 
description  and  imagination  as  for  the  deepest 
philosophic  insight.  "^ 

Intellectual  I  began  by  speaking  of  the  art  of  detachment  as 
that  rare  and  precious  quality  demanded  of  one 
who  wished  to  take  a  philosophical  view  of  the 
profession  as  a  whole.  In  another  way  and  in 
another  sense  this  art  may  be  still  more  precious. 
There  is  possible  to  each  one  of  us  a  higher  type  of 
intellectual  detachment,  a  sort  of  separation  from 
the  vegetative  life  of  the  workaday  world — always 
too  much  with  us — which  may  enable  a  man  to  gain 
a  true  knowledge  of  himself  and  of  his  relations  to 
his  fellows.  Once  attained,  self-deception  is  im- 
possible, and  he  may  see  himself  even  as  he  is  seen 
— not  always  as  he  would  like  to  be  seen — and  his 
own  deeds  and  the  deeds  of  others  stand  out  in 
their  true  light.  In  such  an  atmosphere  pity  for 
himself  is  so  commingled  with  sympathy  and  love 
for  others  that  there  is  no  place  left  for  criticism 
or  for  a  harsh  judgement  of  his  brother.  But,  as 
Sir  Thomas  Browne — most  liberal  of  men  and 
most  distinguished  of  general  practitioners — so 
beautifully  remarks  :  '  These  are  thoughts  of  things 
which  thoughts  but  tenderly  touch,'  and  it  may  be 


detachment. 


THOROUGHNESS    IN    MEDICINE  87 

suflScient  to  remind  this  audience,  made  up  of  prac- 
tical men,  that  the  word  of  action  is  stronger  than 
the  word  of  speech.  '^ 

In  the  first  place,  acquire  early  the  arf  of  detach-  The  art  of 
ment^  by  which  I  mean  the  faculty  of  isolating 
yourselves  from  the  pursuits  and  pleasures  incident 
to  youth. "    (See  Work^ 

Occasionally  we  do  find  an  individual  who  takes 
to  toil  as  others  to  pleasure,  but  the  majority  of  us 
have  to  wrestle  hard  with  the  original  Adam,  and 
find  it  no  easy  matter  to  'scorn  delights  and  live 
laborious  days.'"     (See  ?Pb^>&.) 

Of  special  importance  is  this  gift  (of  isolating 
yourselves  from  the  pursuits  and  pleasures  incident 
to  youth)  to  those  of  you  who  reside  for  the  first 
time  in  a  large  city,  the  many  attractions  of  which 
offer  a  serious  obstacle  to  its  acquisition.  The 
discipline  necessary  to  secure  this  art  brings  in  its 
train  habits  of  self-control,  and  forms  a  valuable 
introduction  to  the  stern  realities  of  life.^^  (See 
Work\ 

I  need  scarcely  warn  you  against  too  close  atten- 
tion to  your  studies.  I  have  yet  to  meet  a  medical 
student,  the  heyday  in  whose  blood  had  been 
quite  tamed  in  his  college  days ;  but  if  you  think 
I  have  placed  too  much  stress  upon  isolation  in 
putting  the  art  of  detachment  first  in  order  amongst 
the  desiderata^  let  me  temper  the  hard  saying  by 


88    HONESTY,    TRUTH,    ETC.,    IN    MEDICINE 

telling  you  how  with  '  labours  assiduous  due  plea- 
sures to  mix.' "     (See  Work.) 

Pills  and        It  cannot  be  denied  that  we  have  learned  more 
po  ons.  rapidly  how  to  prevent  than  how  to  cure  diseases, 

but  with  a  definite  outline  of  our  ignorance  we  no 
longer  live  now  in  a  fool's  paradise,  and  fondly 
imagine  that  in  all  cases  we  control  the  issues  of 
life  and  death  with  our  pills  and  potions.  ^^ 

It  took  the  profession  many  generations  to  learn 
that  fevers  ran  their  course,  influenced  very  little,  if 
at  all,  by  drugs,  and  the  £60  which  old  Dover 
complained  was  spent  in  drugs  in  a  case  of  ordi- 
nary fever  about  the  middle  of  the  eighteenth 
century  is  now  better  expended  on  a  trained  nurse, 
with  infinitely  less  risk,  and  with  infinitely  greater 
comfort  to  the  patient.  ^^ 

With  the  diminished  reliance  upon  drugs,  there 
has  been  a  return  with  profit  to  the  older  measures 
of  diet,  exercise,  baths,  and  frictions,  the  remedies 
with  which  the  Bithynian  Asclepiades  doctored  the 
Romans  so  successfully  in  the  first  century.  ^^ 

Though  used  less  frequently,  medicines  are  now 
griven  with  infinitely  greater  skill ;  we  know  better 
their  indications  and  contra-indications;  and  we  may 
safely  say  (reversing  the  proportion  of  fifty  years 
ago)  that  for  one  damaged  by  dosing,  one  hundred 
are  saved.  ^^ 


ENCOURAGEMENT  AND  INFLUENCE 
IN  MEDICINE 


MISSIONARY  WORK 

There  are  regions,  in  partibus  in^dellutn,  to  which  you 
will  go  as  missionaries,  carrying  the  gospel  of  loyalty  to 
truth  in  the  science  and  in  the  art  of  medicine,  and  your 
lives  of  devotion  may  prove  to  many  a  stimulating 
example.  '^ 


go   ENCOURAGEMENT  AND  INFLUENCE 

As  willing  to  You  cannot  afford  to  stand  aloof  from  your  pro- 
bTteuSit°  fessional  colleagues  in  any  place.  Join  their  associa- 
tions, mingle  in  their  meetings,  giving  of  the  best 
of  your  talents,  gathering  here,  scattering  there ; 
but  everywhere  showing  that  you  are  at  aU  times 
faithful  students,  as  willing  to  teach  as  to  be 
taught.  ""^ 

Masters  in  Linacre  and  his  successors,  Caius,  Harvey,  and 
medicine.  Glisson,  brought  the  new  learning  from  Italy,  and, 
moreover,  gave  to  English  medicine  that  smack  of 
culture,  that  tincture  so  peculiarly  its  own.  From 
Holland  a  succeeding  generation  drew  rich  stores 
of  knowledge,  and  the  methods  of  teaching  of  the 
great  Boerhaave  were  quickly  adopted  by  English 
and  Scotch  students.  From  France  came  next  the 
new  science  of  Bichat,  the  new  art  of  Laennec,  and 
the  new  methods  of  Louis.  To  another  group  the 
great  teachers  of  Austria  contributed  accuracy  in 
clinical  methods,  a  zest  for  the  study  of  special 
branches  and  a  much- needed,  at  the  time,  thera- 
peutic nihilism.  The  debt  of  the  present  genera- 
tion to  Germany  can  never  be  paid.  Think  of  the 
scores  who  have  found  inspiration  in  our  common 
master  Virchow;  and  in  the  scientific  study  of 
disease  the  Fatherland  is  still  in  the  van.  The 
great  republic  of  medicine  knows  and  has  known 
no  national  boundaries,  and  post-graduate  study 
in  other  lands  gives  that  broad  mental  oudook 
and  that  freedom  from  the  trammels  of  local 
prejudice  which  have  ever  characterized  the  true 
physician.  ^ 


IN    MEDICINE  91 

Powerful  as  was  the  effect  of  Louis's  writings  on  Louis:  his 
American  medicine,  it  cannot  compare  with  the  tiu-^^^i^is 
influence  which  he  exerted  through  his  pupils,  who  pupils. 
'  caught  his  clear  accents,  learned  his  great  language, 
made  him  their  model.'  Of  the  great  triumvirate 
of  the  French  school  of  the  fourth  decade,  Louis 
possessed  a  singoilar  power  of  attracting-  hard- 
working capable  men,  and  this  in  spite  of  the  fact 
that  his  rivals  and  friends,  Chomel  and  Andral, 
possessed  more  brilliant  gifts  of  a  certain  kind. 
As  a  writer  in  the  Lancet  said  (1872,  II), '  Year  by 
year  fresh  bands  of  students  came  to  imbibe  from 
his  lips  the  instruction  which  their  predecessors 
had  abandoned  with  reluctance,  till  his  academic 
progeny  knew  no  distinction  of  race  or  even  colour, 
but  coalesced  into  a  noble  band  of  enthusiasts  in 
the  cause  of  medicine,  of  science,  and  of  humanity.' 
In  this  academic  progeny  Louis's  American  pupils 
take  a  very  unusual  position.  Among  the  thousands 
in  the  profession  of  this  country  who  have  during- 
this  century  sought  light  and  learning  in  the  older 
lands,  the  group  of  young  men  who  studied  in  Paris, 
between  1830  and  1840,  had  no  predecessors  and 
have  had  no  successors.  Partly  because  the  time 
was  ripe,  and  they  were  active  agents  in  bringing- 
the  new  art  and  science  to  the  New  World,  partly 
owing  to  inherent  capabilities,  &c.,  but  not  a  little 
because  the  brightest  minds  among-  them  fell  under 
the  influence  of  Louis — they  more  than  any  others 
gave  an  impetus,  which  it  still  feels,  to  the  scientific 
study  of  medicine  in  the  United  States.  ^ 


SILENCE  AND  SELF-CONTROL 


AEQUANIMITAS 

Let  me  recall  to  your  minds  an  incident  related  of  that 
best  of  men  and  wisest  of  rulers,  Antoninus  Pius,  who, 
as  he  lay  dying  in  his  home  at  Lorium  in  Etruria,  summed 
up  the  philosophy  of  life  in  the  watchword,  Aequanimltas. 
As  for  him,  about  to  pass  flammantia  moenia  mundi  (the 
flaming  ramparts  of  the  world),  so  for  you,  fresh  from 
Clotho's  spindle,  a  calm  equanimity  is  the  desirable 
attitude.  =" 


94 


SILENCE   AND 


The 

careless 

tongue. 


The  unruly 
member. 


The  discreet 
nurse. 


Imperturba- 
bility. 


*  Well,  so  have  I,  and  you  ought  always  to  put  the 
most  charitable  construction  on  such  remarks ; 
the  same  people  when  I  come  back  will  pro- 
bably say  I  have  returned.  Sometimes  remarks  of 
this  sort  are  made  carelessly,  as  men  trample  upon 
worms ;  sometimes  from  wantonness,  as  boys  pull 
off  the  wings  of  flies  and  pierce  them  with  pins  ; 
sometimes  for  spite,  as  we  kill  fleas ;  sometimes 
for  experiment,  as  philosophers  torture  dogs ;  but 
seldom  from  wickedness,  as  pagans  skin  saints,  and 
as  Christians  skin  one  another.' "     (Bassett.) 

<^ 
Things  medical  and  gruesome  have  a  singular 
attraction  for  many  people,  and  in  the  easy  days  of 
convalescence  a  facile-tongued  nurse  may  be  led  on 
to  tell  of  '  moving  incidents '  in  ward  or  theatre, 
and  once  untied,  that  unruly  member  is  not  apt 
to  cease  wagging  with  the  simple  narration  of 
events.'  '^ 

To  talk  of  diseases  is  a  sort  of  Arabian  Nights' 
entertainment  to  which  no  discreet  nurse  wiU  lend 
her  talents.  '^ 

In  a  true  and  perfect  form,  imperturbability  is  in- 
dissolubly  associated  with  wide  experience  and  an 
intimate  knowledge  of  the  varied  aspects  of  disease. 
With  such  advantages  he  is  so  equipped  that  no 
eventuality  can  disturb  the  mental  equilibrium  of 
the  physician  ;  the  possibilities  are  always  manifest, 
and  the  course  of  action  clear. '° 

Imperturbability  means  coolness  and  presence  of 
mind  under  all  circumstances,  calmness  amid  storm, 


SELF-CONTROL  95 

clearness  of  judgement  in  moments  of  grave  peril, 
immobility,  impassiveness,  or,  to  use  an  old  and 
expressive  word,  phlegm.  It  is  the  quality  which 
is  most  appreciated  by  the  laity,  though  often  mis- 
understood by  them ;  and  the  physician  who  has 
the  misfortune  to  be  without  it,  who  betrays  in- 
decision and  worry,  and  who  shows  that  he  is 
flustered  and  flurried  in  ordinary  emergencies, 
loses  rapidly  the  confidence  of  his  patients.  ^° 

From  its  very  nature  this  precious   quality  (im-  Iinpertur- 

perturbability)  is  liable  to  be  misinterpreted,  and  "*     y. 

the  general  accusation  of  hardness,  so  often  brought  taken  for 

against  the  profession,  has  here  its  foundation.  ^°  hardness. 

Keen   sensibility    is    doubtless   a  virtue   of  high  Value  of 
order,  when  it  does  not  interfere  with  steadiness  of  callous- 

I16SS« 

hand  or  coolness  of  nerve  ;  but  for  the  practitioner 
in  his  working-day  world,  a  callousness  which 
thinks  only  of  the  good  to  be  effected,  and  goes 
ahead  regardless  of  smaller  considerations,  is  the 
preferable  quality.  ^° 

It  is  sad  to   think  that,  for  some  of  you,  there  Failure, 
is  in  store  disappointment,  perhaps  failure.    You 
cannot  hope,  of  course,  to  escape  from  the  cares 
and  anxieties  incident  to  professional  life.     Stand 
up  bravely,  even  against  the  worst.  ^° 

The  first  essential  is  to  have  your  nerves  well  in  Vaso- 
hand.  Even  under  the  most  serious  circumstances,  "^0^°^ 
the  physician  or  surgeon  who  allows  '  his  outward 


96 


SILENCE    AND 


inscrutable 
face< 


action  to  demonstrate  the  native  act  and  figure 
of  his  heart  in  complement  extern,'  who  shows 
in  his  face  the  slightest  alteration,  expressive  of 
anxiety  or  fear,  has  not  his  medullary  centres  under 
the  highest  control,  and  is  liable  to  disaster  at  any 
moment.  I  have  spoken  of  this  to  you  on  many 
occasions,  and  have  urged  you  to  educate  your 
nerve  centres  so  that  not  the  slightest  dilator  or 
contractor  influence  shall  pass  to  the  vessels  of  your 
face  under  any  professional  trial.  ^° 

Value  of  an  Far  be  it  from  me  to  urge  you,  ere  Time  has 
carved  with  his  hours  those  fair  brows,  to  quench 
on  all  occasions  the  blushes  of  ingenuous  shame, 
but  in  dealing  with  your  patients  emergencies 
demanding  these  should  certainly  not  arise,  and 
at  other  times  an  inscrutable  face  may  prove  a 
fortune.  ^° 

And  in  closing,  may  I  say  a  few  words  to 
the  younger  practitioners  in  the  audience  whose 
activities  will  wax,  not  wane,  with  the  growing  years 
of  the  century  which  opens  so  auspiciously  for  this 
school,  for  this  city,  and  for  our  country.  You 
enter  a  noble  heritage,  made  so  by  no  efforts  of 
your  own,  but  by  the  generations  of  men  who  have 
unselfishly  sought  to  do  the  best  they  could  for 
suifering  mankind.  Much  has  been  done,  much 
remains  to  do  ;  a  way  has  been  opened,  and  to  do 
the  possibilities  in  the  scientific  development  of 
medicine  there  seems  to  be  no  limit.  Except  in  its 
application,  as  general  practitioners,  you  will  not 


The  silent 
workers. 


SELF-CONTROL  97 

have  much  to  do  with  this.  Yours  is  a  higher  and 
more  sacred  duty  :  think  not  to  light  a  light  before 
men  that  they  may  see  your  good  works  ;  contrari- 
wise, you  belong  to  the  great  army  of  quiet  workers, 
physicians  and  priests,  sisters  and  nurses,  all  the 
world  over,  the  members  of  which  strive  not, 
neither  do  they  cry,  nor  are  their  voices  heard  in 
the  streets,  but  to  them  is  given  the  ministry  of 
consolation  in  sorrow,  need,  and  sickness.  Like 
the  ideal  wife  of  whom  Plutarch  speaks,  the  best 
doctor  is  often  the  one  of  whom  the  public  hears 
the  least;  but  nowadays,  in  the  fierce  light  that 
beats  upon  the  hearth,  it  is  increasingly  difficult  to 
lead  the  secluded  life  in  which  our  best  work  is 
done.  To  you  the  silent  workers  of  the  ranks,  in 
villages  and  country  districts,  in  the  slums  of  our 
large  cities,  in  the  mining  camps  and  factory  towns, 
in  the  homes  of  the  rich,  and  in  the  hovels  of  the 
poor,  to  you  is  given  the  harder  task  of  illustrating 
with  your  lives  the  Hippocratic  standards  of  learn- 
ing, of  sagacity,  of  humanity,  and  of  probity.  Of 
learning,  that  you  may  apply  in  your  practice  the 
best  that  is  known  in  our  art,  and  that  with  the 
increase  in  your  knowledge  there  may  be  an  in- 
crease in  that  priceless  endowment  of  sagacity,  so 
that  to  all,  everywhere,  skilled  succour  may  come 
in  the  hour  of  need.  Of  a  humanity,  that  will 
show,  in  your  daily  life,  tenderness  and  considera- 
tion to  the  weak,  infinite  pity  to  the  suffering,  and 
broad  charity  to  all.  Of  a  probity,  that  will  make 
you  under  all  circumstances  true  to  yourselves,  true 
to  your  high  calling,  and  true  to  your  fellow  man.  ""* 

H 


PATIENT  DEVOTION  TO  DUTY  AND 
HIGH  IDEALS 


THE  CALL  OF  LIFE 

Chief  among  tiie  hard  sayings  of  the  Gospels  is  the 
declaration,  He  that  loveth  fother  or  mother  or  son  or 
daughter  more  than  Me  is  not  worthy  of  Me.  Yet  the 
Spirit  has  made  possible  its  acceptance,  and  that  which  is 
responsible  for  Christianity  as  it  is — or  rather,  perhaps,  as 
it  was — is  the  same  which  in  all  ages  has  compelled  men 
to  follow  ideals,  even  at  the  sacrifice  of  the  near  and  dear 
ones  at  home.  In  varied  tones,  to  all,  at  one  time  or 
another,  the  call  comes ;  to  one,  to  forsake  all  and  follow 
Him ;  to  another,  to  scorn  delights  and  live  the  laborious 
days  of  a  student ;  to  the  third,  to  renotmce  all  in  the  life 
Sannyasi.  Many  are  the  wand-bearers,  few  are  the  mystics, 
as  the  old  Greek  has  it,  or,  in  the  words  which  we  know 
better,  *  many  are  called,  but  few  are  chosen.'  The  gifts  were 
diversified,  but  the  same  spirit  animated  the  •  flaming  heart 
of  St  Theresa,'  the  patient  soul  of  PaUssy  the  potter,  and 
the  mighty  intellect  of  John  Hunter. " 


H  2 


lOO  PATIENT    DEVOTION    TO 

The  busy,       .  ,  .  What  I  mean  by  '  better  women '  is  that  the 

hax)pvS^       eyes  of  your  souls  have  been  opened,  the  range 

of  your  sympathies  has  been  widened,  and  your 

characters  have  been  moulded   by  the   events  in 

which  you  have  been  participators  during  the  past 

two  years.  ^* 

<^ 

Practically  there  should  be  for  each  of  you  a  busy, 
useful,  and  happy  life ;  more  you  cannot  expect ; 
a  greater  blessing  the  world  cannot  bestow.  '"* 

<^ 
Busy  you  will  certainly  be,  as  the  demand  is  great, 
both  in  private  and  public,  for  women  with  your 
training. 

Useful  your  lives  must  be,  as  you  will  care  for 
those  who  cannot  care  for  themselves,  and  who 
need  about  them,  in  the  day  of  tribulation,  gentle 
hands  and  tender  hearts.  ** 

A  debt  to       And  happy  lives  shall  be  yours,  because  busy  and 

our  times.       useful ;  having  been  initiated  into  the  great  secret 

that  happiness  lies  in  absorption  in  some  vocation 

which  satisfies  the  soul ;  that  we  have  here  to  add 

what  we  can  /<?,  not  to  get  what  we  oasifroniy  life.  ^* 

Great  men.  *  I  am  glad  I  know  what  great  men  are.  I  am  glad 
I  know  of  what  they  are  made,  and  how  they  made 
themselves  great,  though  this  knowledge  has  broken 
the  last  of  my  household  gods ;  yet  it  has  taken 
away  the  flaming  sword  that  stood  before  the  gates 
of  this  Paradise,  where  may  still  be  seen  the  track 
of  the  serpent  and  of  the  devil  himself,  so  I  will  keep 
out  of  bad  company.' "     (Bassett.) 


less. 


DUTY   AND    HIGH    IDEALS  101 

Nowhere  in  ancient  history,  sacred  or  profane,  do  Women : 
we  find  instances  of  the  devoted  heroism  of  women  °^^  ^^^  °^^' 
such  as  dot  the  annals  of  the  Catholic  Church,  or  such 
as  can  be  paralleled  in  our  own  century.  Tender 
maternal  affection,  touching  filial  piety,  were  there; 
but  the  spirit  abroad  was  that  of  Deborah  not  of 
Rizpah,  of  Jael  not  Dorcas.  '* 

The  saddest  lament  in  Oliver  Wendell  Holmes's  The  voice- 
poems  is  for  the  voiceless, — 

'  for  those  who  never  sing-, 
But  die  with  all  their  music  in  them.' 

The  extracts  which  I  have  read  show  Dr.  Bassett 
to  have  been  a  man  of  no  ordinary  gifts,  but  he  was 
among  the  voiceless  of  the  profession.  Nowadays, 
environment,  the  opportunity  for  work,  the  skirts 
of  happy  chance,  carry  men  to  the  summit.  To 
those  restless  spirits  who  have  had  ambition  without 
opportunities,  and  ideals  not  realizable  in  the  world 
in  which  they  move,  the  story  of  his  life  may  be 
a  solace.  I  began  by  saying  that  I  would  tell  you 
of  a  man  of  whom  you  had  never  heard,  of  a  humble 
student  in  a  litde  town  in  Alabama.  What  of  the 
men  whom  he  revered,  and  for  whom  in  1836  he 
left  wife  and  children  .'*  Are  they  better  known  to 
us  .-*  To-day  scarcely  one  of  those  whom  he  men- 
tions touches  us  with  any  firmness  from  the  past. 
Of  a  majority  of  them  it  may  be  said,  they  are  as 
though  they  had  not  been.  Velpeau,  Andral, 
Broussais,  the  great  teachers  whom  Bassett  followed, 
are  shadowy  forms  (almost  as  indistinct  as  the  pupil). 


102  PATIENT    DEVOTION   TO 

dragged  out  to  the  daylight  by  some  laudator  teffi- 
poris  acti^  who  would  learn  philosophy  in  history. 
To  have  striven,  to  have  made  an  effort,  to  have 
been  true  to  certain  ideals — these  alone  are  worth 
the  struggle.  Now  and  again  in  a  generation,  one 
or  two  snatch  something  from  dull  oblivion ;  but 
for  the  rest  of  us,  sixty  years .' — we,  too,  are  with 
Bassett  and  his  teachers — and 

'  no  one  asks 
Who  or  what  we  have  been, 
More  than  that  he  asks  what  waves, 
In  the  moonlit  solitudes  mild 
Of  the  midmost  ocean,  have  swelled, 
Foam'd  for  a  moment,  and  gone.''^ 

Visions  of      lb  a  friend  Bassett  writes  on  the  date  of  April  5 : — 

'  This  world  has  never  occupied  a  larger  share  of 
my  attention  or  love.  I  have  asked  but  little  of  it, 
and  got  but  little  of  what  I  asked.  It  has  for  many 
years  been  growing  less  and  less  in  my  view,  like 
a  receding  spirit  in  space ;  but  no  better  land  has 
appeared  to  my  longing  vision ;  what  lies  beyond 
me  has  become  insignificant,  before  me  it  is  a  vast 
interminable  void,  but  not  a  cheerless  one,  as  it  is 
full  of  pleasant  dreams  and  visions  and  glorious 
hopes.  I  have  covered  it  with  the  landscape  of 
Claude,  and  peopled  it  with  the  martyrs  of  science, 
the  pioneers  of  truth,  the  hound-hunted  and  crucified 
of  this  world,  that  have  earned  apd  then  asked  for 
bread  and  received  a  serpent — all  who  have  suffered 
for  the  truth.  How  glorious  it  is  to  contemplate  in 
the  future  these  time -buffeted  at  rest,  with  their 
lacerated  feelings  soothed  as  mine  have  been  this 
day  by  the  tender  regard  your  wife  has  manifested 
for  my  future  well-being.'  '^ 


DUTY   AND   HIGH    IDEALS  103 

In  the  older  States  utility  is  no  longer  regarded  as  The  utility 
the  test  of  fitness,  and  the  value  of  the  intellectual  °'^' 
life  has  risen  enormously  in  every  department. 
Germany  must  be  our  model  in  this  respect.  She 
is  great  because  she  has  a  large  group  of  men  pur- 
suing pure  science  with  unflagging  industry,  with 
self-denying  zeal,  and  with  high  ideals.  No  second- 
ary motives  sway  their  minds,  no  cry  reaches  them 
in  the  recesses  of  their  laboratories,  'Of  what  practical 
utility  is  your  work  ? '  but,  unhampered  by  social  or 
theological  prejudices,  they  have  been  enabled  to 
cherish  '  the  truth  which  has  never  been  deceived — 
that  complete  truth  which  carries  with  it  the  antidote 
against  the  bane  and  danger  which  follow  in  the 
train  of  half-knowledge.' "     (Helmholtz.) 

A  conscientious  pursuit  of  Plato's  ideal  perfection  The  three 
may  teach  you  the  three  great  lessons  of  life.  You  ^^g  ''^"^ 
may  learn  to  consume  your  own  smoke.  The 
atmosphere  is  darkened  by  the  murmurings  and 
whimperings  of  men  and  women  over  the  non- 
essentials, the  trifles  that  are  inevitably  incident  to 
the  hurly-burly  of  the  day's  routine.  Things  cannot 
always  go  your  way.  Learn  to  accept  in  silence  the 
minor  aggravations,  cultivate  the  gift  of  taciturnity 
and  consume  your  own  smoke  with  an  extra  draught 
of  hard  work,  so  that  those  about  you  may  not  be 
annoyed  with  the  dust  and  soot  of  your  complaints. 
More  than  any  other  the  practitioner  of  medicine 
may  illustrate  the  second  great  lesson,  that  we  are 
here  not  to  get  all  we  can  out  of  life  for  ourselves, 
but  to  try  to  make  the  lives  of  others  happier.   This 


I04  PATIENT    DEVOTION    TO 

is  the  essence  of  that  oft-repeated  admonition  of 
Christ,  '  He  that  findeth  his  hfe  shall  lose  it,  and  he 
that  loseth  his  life  for  My  sake  shall  find  it,'  on 
which  hard  saying  if  the  children  of  this  generation 
would  only  lay  hold,  there  would  be  less  misery  and 
discontent  in  the  world.  It  is  not  possible  for  any 
one  to  have  better  opportunities  to  live  this  lesson 
than  you  will  enjoy.  The  practice  of  medicine  is 
an  art,  not  a  trade ;  a  calling,  not  a  business ; 
a  calling  in  which  your  heart  will  be  exercised 
equally  with  your  head.  Often  the  best  part  of 
your  work  will  have  nothing  to  do  with  potions 
and  powders,  but  with  the  exercise  of  an  influence 
of  the  strong  upon  the  weak,  of  the  righteous  upon 
the  wicked,  of  the  wise  upon  the  foolish.  To  you, 
as  the  trusted  family  counsellor,  the  father  will  come 
with  his  anxieties,  the  mother  with  her  hidden  grief, 
the  daughter  with  her  trials,  and  the  son  with  his 
follies.  Fully  one- third  of  the  work  you  do  will  be 
entered  in  other  books  than  yours.  Courage  and 
cheerfulness  will  not  only  carry  you  over  the  rough 
places  of  life,  but  will  enable  you  to  bring  comfort 
and  help  to  the  weak-hearted  and  will  console  you 
in  the  sad  hours  when,  like  Uncle  Toby,  you  have 
'  to  whistle  that  you  may  not  weep.'^"* 

The  student  Learn  to  love  the  freedom  of  the  student  life,  only 
too  quickly  to  pass  away ;  the  absence  of  the  coarser 
cares  of  after  days,  the  joy  in  comradeship,  the 
delight  in  new  work,  the  happiness  in  knowing  that 
you  are  making  progress.  Once  only  can  you  enjoy 
these  pleasures.    The  seclusion  of  a  student  life  is 


DUTY   AND    HIGH    IDEALS  105 

not  always  good  for  a  man,  particularly  for  those 
of  you  who  will  in  after  years  engage  in  general 
practice,  since  you  will  miss  that  facility  of  inter- 
course upon  which  often  the  doctor's  success 
depends.  On  the  other  hand  sequestration  is 
essential  for  those  of  you  with  high  ambitions  pro- 
portionate to  your  capacity.  It  was  for  such  that 
St.  Chrysostom  gave  his  famous  counsel :  '  Depart 
from  the  highways  and  transplant  thyself  into  some 
enclosed  ground,  for  it  is  hard  for  a  tree  that  stands 
by  the  wayside  to  keep  its  fruit  till  it  be  ripe.'  '* 

Sitting  in  Lincoln  Cathedral  and  gazing  at  one  of  Ideals,  value 
the  loveliest  of  human  works — for  such  the  angel  °^ 
choir  has  been  said  to  be — there  arose  within  me, 
obliterating  for  the  moment  the  thousand  heraldries 
and  twilight  saints  and  dim  emblazonings,  a  strong 
sense  of  reverence  for  the  minds  which  had  con- 
ceived and  the  hands  which  had  executed  such 
things  of  beauty.  What  manner  of  men  were  they 
who,  in  those  (to  us)  dark  days,  could  build  such 
transcendent  monuments  ?  What  was  the  secret  of 
their  art  ?  By  what  spirit  were  they  moved  ? 
Absorbed  in  thought,  I  did  not  hear  the  beginning 
of  the  music,  and  then,  as  a  response  to  my  reverie 
and  arousing  me  from  it,  rang  out  the  clear  voice 
of  the  boy  leading  the  antiphon, '  That  Thy  power, 
Thy  glory,  and  the  mightinessof  Thy  kingdom  might 
be  known  unto  men.'     Here  was  the  answer.  ^^ 

Always  seek  your  own  interests,  make  of  a  high 
and  sacred  calling  a  sordid  business,  regard  your 


I06  PATIENT    DEVOTION   TO 

fellow  creatures  as  so  many  tools  of  trade,  and,  if 
your  heart's  desire  is  for  riches,  they  may  be  yours ; 
but  you  will  have  bartered  away  the  birthright  of 
a  noble  heritage,  traduced  the  physician's  weU- 
deserved  title  of  the  Friend  of  Man,  and  falsified 
the  best  traditions  of  an  ancient  and  honourable 
guild.  *^ 

And  though  this  course  does  not  necessarily 
bring  position  or  renown,  consistently  followed  it 
will  at  any  rate  give  to  your  youth  an  exhilarating 
zeal  and  a  cheerfulness  which  will  enable  you  to 
surmount  all  obstacles — to  your  maturity  a  serene 
judgement  of  men  and  things,  and  that  broad 
charity  without  which  all  else  is  nought — to  your 
old  age  that  greatest  of  blessings,  peace  of  mind ; 
a  realization,  maybe,  of  the  prayer  of  Socrates  for 
the  beauty  in  the  inward  soul  and  for  unity  of  the 
outer  and  the  inner  man  ;  perhaps,  of  the  promise 
of  St.  Bernard,  pax  sine  crintine^  pax  sine  turbine^ 
pax  sine  rixa.  ^^ 

And,  if  the  fight  is  for  principle  and  justice,  even 
when  failure  seems  certain,  where  many  have  failed 
before,  cling  to  your  ideal,  and,  like  Childe  Roland 
before  the  dark  tower,  set  the  slug-horn  to  your 
lips,  blow  the  challenge,  and  calmly  await  the 
conflict.  ^° 

Not  that  we  all  live  up  to  the  highest  ideals,  far 
from  it — we  are  only  men.  But  we  have  ideals, 
which  mean  much,  and  they  are  realizable,  which 
means  more.  ^^ 


DUTY   AND    HIGH    IDEALS  107 

Of  course  there  are  Gehazis  among  us  who  serve  The 
for  shekels,  whose  ears  hear  only  the  lowing-  of  the  ^®"^2^^ 
oxen  and  the  jingling  of  the  guineas,  but  these  are 
exceptions.     The  rank  and  file  labour  earnestly  for 
your  good,  and  self-sacrificing  devotion  to  your 
interests  animates  our  best  work.  ^^ 

No  other  profession  can  boast  of  the  same  unbroken  Methods 
continuity  of  methods  and  of  ideals.  We  may  and  ideals, 
indeed  be  jusdy  proud  of  our  apostolic  succession. 
Schools  and  systems  have  flourished  and  gone, 
schools  which  for  generations  have  swayed  the 
thought  of  our  guild  ;  the  philosophies  of  one  age 
have  become  the  absurdities  of  the  next,  and  the 
foolishness  of  yesterday  has  become  the  wisdom  of 
to-morrow ;  through  long  ages  which  were  slowly 
learning  what  we  are  hurrying  to  forget,  amid  all 
the  changes  and  chances  of  twenty-five  centuries, 
the  profession  has  never  lacked  men  who  have  lived 
up  to  these  Greek  ideals.  They  were  those  of  Galen 
and  Aretaeus,  of  men  of  the  Alexandrian  and 
Byzantine  schools,  of  the  best  of  the  Arabians,  of 
the  men  of  the  Renaissance,  and  they  are  ours 
to-day.  ^'^ 

A  second  distinctive  feature  is  the  remarkable 
solidarity.  Of  no  other  profession  is  the  word 
'  universal '  applicable  in  the  same  sense.  The  cele- 
brated phrase  used  of  the  Catholic  Church  is  in 
truth  much  more  appropriate  when  applied  to 
medicine.  It  is  not  the  prevalence  of  disease  or 
the  existence  everywhere  of  special  groups  of  men 


Io8  PATIENT   DEVOTION    TO 

to  treat  it  that  betokens  this  solidarity,  but  it  is  the 
identity  throughout  the  civilized  world  of  our 
ambitions,  our  methods  and  our  work.  To  wrest 
from  nature  the  secrets  which  have  perplexed 
philosophers  in  aU  ages,  to  track  to  their  sources 
the  causes  of  disease,  to  correlate  the  vast  stores  of 
knowledge,  that  they  may  be  quickly  available  for 
the  prevention  and  cure  of  disease — these  are  our 
ambitions.  To  carefully  observe  the  phenomena  of 
life  in  all  its  phases,  normal  and  perverted,  to  make 
perfect  that  most  difficult  of  aU  arts,  the  art  of 
observation,  to  call  to  aid  the  science  of  experi- 
mentation, to  cultivate  the  reasoning  faculty,  so  as 
to  be  able  to  know  the  true  from  the  false— these 
are  our  methods.  To  prevent  disease,  to  relieve 
suffering,  and  to  heal  the  sick — this  is  our  work. 
The  profession  in  truth  is  a  sort  of  guild  or  brother- 
hood, any  member  of  which  can  take  up  his  calling 
in  any  part  of  the  world  and  find  brethren  whose 
language  and  methods  and  whose  aims  and  ways 
are  identical  with  his  own.  '^^ 

Thirdly,  its  progressive  character.  Based  on 
science,  medicine  has  followed  and  partaken  of  its 
fortunes,  so  that  in  the  great  awakening  which  has 
made  the  nineteenth  memorable  among  centuries, 
the  profession  received  a  quickening  impulse  more 
powerful  than  at  any  period  in  its  history.  With 
the  sole  exception  of  the  mechanical  sciences,  no 
other  department  of  human  knowledge  has  under- 
gone so  profound  a  change — a  change  so  profound 
that  we  who  have  grown  up  in  it  have  but  slight 


DUTY   AND    HIGH    IDEALS  I09 

appreciation  of  its  momentous  character.  And  not 
only  in  what  has  been  actually  accomplished  in  un- 
ravelling the  causes  of  disease,  in  perfecting-  methods 
of  prevention,  and  in  wholesale  relief  of  suffering, 
but  also  in  the  unloading  of  old  formulae,  and  in 
the  substitution  of  the  scientific  spirit  of  free  inquiry 
for  cast-Iron  dogmas,  we  see  a  promise  of  still 
greater  achievement  and  of  a  more  glorious 
future.  ^^ 

And  lastly,  the  profession  of  medicine  is  dis- 
tinguished from  all  others  by  its  singular  beneficence. 
It  alone  does  the  work  of  charity  in  a  Jovian  and 
God-like  way,  dispensing  with  a  free  hand  truly 
Promethean  gifts.  There  are  those  who  listen  to 
me  who  have  seen  three  of  the  most  benign  en- 
dowments granted  to  the  race  since  the  great  Titan 
stole  fire  from  heaven.  Search  the  scriptures  of 
human  achievement  and  you  cannot  find  any  way 
to  equal  in  beneficence  the  introduction  of  anaes- 
thesia, sanitation,  with  all  that  it  includes,  and 
asepsis — a  short  half-century's  contribution  towards 
the  practical  solution  of  the  problems  of  human 
suffering,  regarded  as  eternal  and  insoluble.  We 
form  almost  a  monopoly  or  trust  in  this  business. 
Nobody  else  comes  into  active  competition  with  us, 
certainly  not  the  other  learned  professions  which 
continue  along  the  old  lines.  Every  new  year  sees 
some  new  conquest,  so  that  we  have  ceased  to 
wonder.  The  work  of  half  a  dozen  men,  headed 
by  Laveran,  has  made  waste  places  of  the  earth 
habitable,  and  the  wilderness  to  blossom  like  the 


no 


PATIENT   DEVOTION   TO 


Patienoe. 


Persistency 
in  the  midst 
of  loneliness. 


Defeat. 


Face  dis- 
aster boldly. 


Heroism 
and  devo- 
tion. 


rose.  The  work  of  Walter  Reed  and  his  associates 
will  probably  make  yellow  fever  as  scarce  in  the 
Spanish  Main  as  is  typhus  with  us.  There  seems 
to  be  no  limit  to  the  possibilities  of  scientific 
medicine,  and  while  philanthropists  are  turning  to 
it  as  to  the  hope  of  humanity,  philosophers  see,  as 
in  some  far-off  vision,  a  science  from  which  may 
come  in  the  prophetic  words  of  the  Sou  of  Sirach, 
'  Peace  over  all  the  earth.'  '^ 

It  has  been  said  that  *  in  patience  ye  shall  win  your 
souls,'  and  what  is  this  patience  but  an  equanimity 
which  enables  you  to  rise  superior  to  the  trials  of 
life?'° 

Your  very  hopes  may  have  passed  out  of  sight,  as 
did  all  that  was  near  and  dear  to  the  patriarch  at 
the  Jabbok  ford,  and,  like  him,  you  may  be  left  to 
struggle  in  the  night  alone.  Well  for  you,  if  you 
wrestle  on,  for  in  persistency  lies  victory,  and  with 
the  morning  may  come  the  wished- for  blessing.  ^° 

But  not  always  ;  there  is  a  struggle  with  defeat 
which  some  of  you  will  have  to  bear,  and  it  will  be 
well  for  you  in  that  day  to  have  cultivated  a  cheer- 
ful equanimity.  ^° 

Even  with  disaster  ahead  and  ruin  imminent,  it  is 
better  to  face  them  with  a  smile,  and  with  the  head 
erect,  than  to  crouch  at  their  approach.  ^° 

The  sick  love-child  of  Israel's  sweet  singer,  the 
plague-stricken  hopes  of  the  great  Athenian  states- 


DUTY    AND    HIGH    IDEALS  III 

man,  Elpenor,  bereft  of  his  beloved  Artemidora,  and 
•  Tully's  daughter  mourned  so  tenderly,'  are  not  of 
any  age  or  any  race — they  are  here  with  us  to-day, 
with  the  Hamlets,  the  Ophelias,  and  the  Lears. 
Amid  an  eternal  heritage  of  sorrow  and  suffering 
our  work  is  laid,  and  this  eternal  note  of  sadness 
would  be  insupportable  if  the  daily  tragedies  were 
not  relieved  by  the  spectacle  of  the  heroism  and 
devotion  displayed  by  the  actors.  *^ 

Quickly  there  arises  the  memory  of  the  men  who  Devotion 
have  done  so  much  for  British  medicine  in  that  "^""'y* 
great  empire  (India).  Far  from  their  homes,  far 
from  congenial  surroundings,  and  far  from  the 
stimulus  of  scientific  influences,  Annesley,  Ballingall, 
Twining,  Morehead,  Waring,  Parkes,  Cunningham, 
Lewis,  Vandyke  Carter,  and  many  others  have 
upheld  the  traditions  of  Harvey  and  Sydenham.  * 

Nothing  will  sustain  you  more  potently  in  your  Recognize 
humdrum  routine,  as  perhaps  it  may  be  thought,  ^i-F^*^ 
than  the  power  to  recognize  the  true  poetry  of  life —  btimdnun 
the  poetry  of  the  commonplace,  of  the  ordinary  routine, 
man,  of  the  plain,  toil-worn  woman,  with  their 
loves  and  their  joys,  their  sorrows  and  their  griefs. 
The  comedy,  too,  of  life  will  be  spread  before  you, 
and  nobody  laughs  more  often  than  the  doctor  at 
the  pranks  Puck  plays  upon  the  Titanias  and  the 
Bottoms  among  his  patients.     The  humorous  side 
is  really  almost  as  frequently  turned  towards  him 
as  the  tragic.     Lift  up  one  hand  to  heaven  and 
thank  your  stars  if  they  have  given  you  the  proper 


112 


DUTY   AND    HIGH    IDEALS 


Sense  of 
humour  an 
essentiaL 


A  nature 
'  sloping  to- 
wards the 
southern 
side.' 


sense  to  enable  you  to  appreciate  the  Inconceivably 
droll  situations  in  which  we  catch  our  fellow  crea- 
tures. Unhappily,  this  is  one  of  the  free  gifts  of 
the  gods,  unevenly  distributed,  not  bestowed  on  all, 
or  on  all  in  equal  portions.  In  undue  measure  it  is 
not  without  risk,  and  in  any  case  in  the  doctor  it 
is  better  appreciated  by  the  eye  than  expressed  on 
the  tongue.  Hilarity  and  good  humour,  a  breezy 
cheerfulness,  a  nature '  sloping  towards  the  southern 
side,'  as  Lowell  has  it,  help  enormously  both  in  the 
study  and  in  the  practice  of  medicine.  To  many 
of  a  sombre  and  sour  disposition  it  is  hard  to 
maintain  good  spirits  amid  the  trials  and  tribula- 
tions of  the  day,  and  yet  It  is  an  unpardonable 
mistake  to  go  about  among  patients  with  a  long 
face.  *^ 


CHARITY  AND  FRATERNITY 
IN  MEDICINE 


CHARITY 

It  may  be  that  in  the  hurry  and  bustle  of  a  busy  life 
I  have  given  oflFence  to  some — who  can  avoid  it?  Un- 
wittingly I  may  have  shot  an  arrow  o'er  the  house  and 
hurt  a  brother — if  so,  I  am  sorry,  and  I  ask  his  pardon.  So 
far  as  I  can  read  my  heart  I  leave  you  in  charity  with  all. 
I  have  striven  with  none,  not  for  the  reason  given  by 
Walter  Savage  Landor,  because  none  was  worth  the  strife, 
but  because  I  have  had  a  deep  conviction  of  the  hatefulness 
of  strife,  of  its  uselessness,  of  its  disastrous  effects,  and 
a  still  deeper  conviction  of  the  blessings  that  come  with 
unity,  peace,  and  concord.)  And  I  would  give  to  each  one 
of  you,  my  brothers — you  who  hear  me  now,  and  to  you  who 
may  elsewhere  read  my  words— to  you  who  do  our  greatest 
work,  labouring  incessantly  for  small  rewards  in  towns  and 
country  places — to  you  the  more  favoured  ones  who  have 
special  fields  of  work — to  you  teachers  and  professors  and 
scientific  workers— to  one  and  all,  throughout  the  length 
and  breadth  of  the  land — I  give  a  single  word  as  my  parting 

commandment :— 'IT  IS  NOT  HIDDEN  FROM  THEE,  NEITHER 
IS  ITFAR  OFF.  IT  IS  NOT  IN  HEAVEN, THAT  THOU  SHOULDEST 
SAY,  WHO  SHALL  GO  UP  FOR  US  TO  HEAVEN,  AND  BRING 
IT  UNTO  US,  THAT  WE  MAY  HEAR  IT,  AND  DO  IT  ?  NEITHER 
IS  IT  BEYOND  THE  SEA,  THAT  THOU  SHOULDEST  SAY,  WHO 
SHALL  GO  OVER  THE  SEA  FOR  US,  AND  BRING  IT  UNTO  US, 
THAT  WE  MAY  HEAR  IT,  AND  DO  IT  ?  BUT  THE  WORD  IS 
VERY  NIGH  UNTO  THEE.  IN  THY  MOUTH,  AND  IN  THY  HEART, 
THAT  THOU  MAYEST  DO  IT '-CHARITY. '»' 


114  CHARITY   AND    FRATERNITY 

Quarrels  of    The  quarrels  of  doctors  make  a  pretty  chapter  in 
doctors.  ^j^g  history  of  medicine.     Each  generation  seems  to 

have  had  its  own.  The  Coans  and  Cnidians,  the 
Arabians  and  Galenists,  the  humoralists  and  the 
solidists,  the  Brunonians  and  the  Broussaisians,  the 
homoeopaths  and  the  regulars,  have  in  different 
centuries  rent  the  robe  of  Aesculapius.  But  these 
larger  quarrels  are  becoming  less  and  less  intense, 
and  in  the  last  century  no  new  one  of  moment 
sprang  up ;  and  it  is  safe  to  predict  that  in  the 
present  century,  when  science  has  fully  leavened 
the  dough  of  homoeopathy,  the  great  breach  of  our 
day  will  be  healed.  ^^ 

So  far  as  my  observation  goes,  the  fault  lies  with 
the  older  men.  The  young  fellow,  if  handled 
aright  and  made  to  feel  that  he  is  welcomed,  not 
an  intruder  to  be  shunned,  is  only  too  ready  to 
hold  out  the  hand  of  fellowship.  The  medical 
society  comes  in  here  as  professional  cement.  The 
meeting  in  a  friendly,  social  way,  with  a  free  and 
open  discussion  of  affairs,  fosters  a  spirit  that  refuses 
to  recognize  in  differences  of  opinion  on  the  non- 
essentials of  life  a  cause  of  personal  animosity  or  ill- 
feeling.  An  aptitude  of  mind  habitually  friendly, 
more  particularly  to  the  young  man,  even  though 
you  feel  him  to  be  the  David  to  whom  your 
kingdom  may  fall;  a  little  of  the  old-fashioned 
courtesy  which  makes  a  man  shrink  fi-om  wounding 
the  feelings  of  a  brother  practitioner,  in  honour 
preferring  another ; — with  such  a  spirit  abroad  in 
the  society  and  among  its  older  men,  there  is  no 


IN    MEDICINE  115 

room  for  envy,  hatred,  malice,  or  any  uncharitable- 

ness.  '^ 

9 

The  practice  of  medicine  calls  equally  for  the  exer- 
cise of  the  heart  and  the  head ;  and  when  a  man  has 
done  his  best,  to  have  his  motives  misunderstood  and 
his  conduct  of  a  case  harshly  criticized,  not  only  by 
the  family,  but  by  a  colleague  who  has  been  called  in, 
small  wonder,  when  the  opportunity  arises,  if  the  old 
Adam  prevails  and  he  pays  in  kind.  So  far  as  my 
observation  goes,  there  are  three  chief  causes  for 
the  quarrels  of  doctors.  The  first  is  lack  of  proper  Friendly 
friendly  intercourse,  by  which  alone  we  can  know  intercourse 
our  colleagues.  It  is  the  duty  of  the  older  man  to 
look  on  the  younger  one  who  setdes  near  him  not 
as  a  rival,  but  as  a  son.  He  will  do  to  you  just 
what  you  did  to  the  older  practitioner,  when,  as 
a  young  man,  you  started — get  a  good  many  of 
your  cases  ;  but  if  you  have  the  sense  to  realize  that 
this  is  inevitable,  unavoidable,  and  the  way  of  the 
world,  and  if  you  have  the  sense  to  talk  over,  in 
a  friendly  way,  the  first  delicate  situation  that 
arises,  the  difficulties  will  disappear  and  recurrences 
of  a  misunderstanding  may  be  made  impossible. 
The  young  men  should  be  tender  with  the  sensibili- 
ties of  their  seniors,  deferring  to  their  judgement 
and  taking  counsel  with  them.  ^^ 

Whether  a  man  will  treat  his  professional  brethren  Training  an 
in  a  gentlemanly  way  or  in  a  narrow  illiberal  spirit  ^^"^^^^ 
is  partly  a  matter  of  temperament,  partly  a  matter 
of  training.  If  we  had  only  to  deal  with  one  another 

I  2 


ii6 


CHARITY   AND    FRATERNITY 


Charity. 


Drugs — ^the 
most  uncer- 
tain element 
in  our  art 


Homoeo- 
pathy. 


the  difficulties  would  be  slight,  but  it  must  be  con- 
fessed that  the  practice  of  medicine  among  our 
fellow  creatures  is  often  a  testy  and  choleric  business. 
When  one  has  done  his  best,  or  when  a  mistake  has 
arisen  through  lack  of  special  knowledge,  but  more 
particularly  when,  as  so  often  happens,  our  heart's 
best  sympathies  have  been  engaged,  to  be  mis- 
understood by  the  patient  and  his  friends,  to  have 
evil  motives  imputed  and  to  be  maligned,  is  too 
much  for  human  endurance,  and  justifies  a  righteous 
indignation.  "^ 

W^hen  a  man  reaches  the  climacteric,  and  has 
long  passed  beyond  the  professional  stage  of  his 
reputation,  we  who  are  still  'in  the  ring'  must 
exercise  a  good  deal  of  charity,  and  discount  largely 
the  on  diis  which  indiscreet  friends  circulate.  ^ 

It  is  too  late  in  this  day  of  scientific  medicine  to 
prattle  of  such  antique  nonsense  as  is  indicated  in 
the  *pathies.'  We  have  long  got  past  the  stage 
when  any  'system '  can  satisfy  a  rational  practitioner, 
long  past  the  time  when  a  difference  of  belief  in  the 
action  of  drugs — the  most  uncertain  element  in  our 
art — should  be  allowed  to  separate  men  with  the 
same  noble  traditions,  the  same  hopes,  the  same 
aims  and  ambitions.  It  is  not  as  if  our  homoeopathic 
brothers  are  asleep ;  far  from  it,  they  are  awake — 
many  of  them  at  any  rate — to  the  importance  of  the 
scientific  study  of  disease,  and  all  of  them  must 
realize  the  anomaly  of  their  position.  It  is  distress- 
ing to  think  that  so  many  good  men  live  isolated, 


IN    MEDICINE  117 

in  a  measure,  from  the  great  body  of  the  profession. 
The  original  grievous  mistake  was  ours — to  quarrel 
with  our  brothers  over  infinitesimals  was  a  most 
unwise  and  stupid  thing  to  do.  That  we  quarrel 
with  them  now  is  solely  on  account  of  the  old 
Shibboleth  under  which  they  practise.  Homoeopathy 
is  as  inconsistent  with  the  new  medicine  as  is  the 
old-fashioned  polypharmacy,  to  the  destruction  of 
which  it  contributed  so  much.  The  rent  in  the 
robe  of  Aesculapius,  wider  in  this  country  than 
elsewhere,  could  be  repaired  by  mutual  concessions  Mutual  con- 
— on  the  one  hand  by  the  abandonment  of  special  cessions 
designations,  and  on  the  other  by  an  intelligent  ^ssary. 
toleration  of  therapeutic  vagaries  which  in  all  ages 
have  beset  the  profession,  but  which  have  been 
mere  flies  on  the  wheels  of  progress.  *^ 

If   young   graduates  could    be   taken  more  fre-  Attitude  of 

quently  as    assistants   or    partners,   the  work  of  mind  the  all- 

the    profession   would    be   much   lightened,   and  promotion  of 

it  would  promote    amity  and    good   fellowship,  concord. 

A    man    of    whom    you    may    have    heard    as 

the    incarnation  of  unprofessional    conduct,  and 

who  has  been  held  up  as  an  example  of  all  that 

was  pernicious,  may  be,  in  reality,  a  very  good 

fellow,  the  victim  of  petty  jealousies,  the  mark  of 

the  arrows  of  a  rival  faction ;  and  you  may  be 

surprised  to  find  that  he  loves  his  wife,  and  is 

devoted  to  his  children,  and  that  there  are  people 

who  respect  and  esteem  him.    After  all,  the  attitude 

of  mind  is  the  all -important  factor  in  the  promotion 

of  concord.    When  a  man   is  praised,  or  when 


it8        charity  and  fraternity 

a  young  man  has  done  a  good  bit  of  work  in  your 
special  branch,  be  thankful — it  is  for  the  common 
good.  Envy,  that  pain  of  the  soul,  as  Plato  calls 
it,  should  never  for  a  moment  afflict  a  man  of 
generous  instincts  who  has  a  sane  outlook  in 
life.  The  men  of  rival  schools  should  deliberately 
cultivate  the  acquaintance  of  each  other  and  en- 
courage their  students  and  the  junior  teachers  to 
Say  a  good    fraternize.     If  you  hear  that  a  young  fellow  just 

word  for  the  starting  has  made  mistakes  or  is  a  little  '  off  colour,' 
'off  colour*  .  1  1       1  • 

man.  S^  ^^^  °f  your  way  to  say  a  good  word  to  him,  or 

for  him.     It  is  the  only  cure ;  any  other  treatment 

only  aggravates  the  malady.  *^ 


Uncharita-     The  most  widespread,  the  most  pernicious  of  all 
blenessmost  yj^es,  equal  in  its  disastrous  effects  to  impurity, 
of  all  vices,     much    more   disastrous  often   than  intemperance, 
because  destructive  of  all  mental  and  moral  nobility, 
as  are  the   others  of  bodily  health,  is   unchari- 
tableness — the    most    prevalent  of   modern    sins, 
peculiarly  apt  to  beset   all  of  us,  and  the  chief 
A  thought-     enemy  to  concord  in  our  ranks.     Oftentimes  it  is 
ti^s  ^  thoughtless  evil,  a  sort  of  ftc  or  trick,  an  un- 

conscious habit  of  mind  and  tongue  which  gradually 
takes  possession  of  us.  No  sooner  is  a  man's 
name  mentioned  than  something  slighting  is  said 
of  him,  or  a  story  is  repeated  which  is  to  his 
disadvantage,  or  the  involuntary  plight  of  a 
brother  is  ridiculed,  or  even  his  character  is  tra- 
duced. In  chronic  and  malign  offenders  literally, 
'with  every  word  a  reputation  dies.'    The  work 


IN    MEDICINE  119 

of  a  school  is  disparaged,  or  the  character  of  the 

work  in  a  laboratory  is  belittled ;    or  it  may  be 

only  the  faint  praise  that  damns,  not  the  generous  The  feint 

meed  from  a  fuU  and  thankful  heart.     We  have  faisetiiat 

damns, 
lost  our  fine  sense  of  the  tragic  element  in  this  vice, 

and  of  its  debasing  influence  on  the  character.     It 

is  interesting  that  Christ  and  the  Apostles  lashed 

it    more    unsparingly   than    any   other.     Who    is 

there  among  us  who  does  not  require  every  day 

to  take  to  heart  that  counsel  of  perfection :  'Judge 

not  according  to  the  appearance,  but  judge  righteous 

judgement '  ?    One  of  the  aposdes  of  our  profession, 

Sir  Thomas  Browne,  has  a  great  thought  on  the 

question : — 

'While  thou  so  hotly  disclaimest  the  devil, 
be  not  guilty  of  diabolism.  Fall  not  into  one 
name  with  that  unclean  spirit,  nor  act  his  nature 
whom  thou  so  much  abhorrest — that  is,  to  accuse, 
calumniate,  backbite,  whisper,  detract,  or  sinis- 
trously  interpret  others.  Degenerous  depravi- 
ties, and  narrow-minded  vices!  not  only  below 
St.Paul's  noble  Christian, but  Aristotle's  true  gentle- 
man. Trust  not  with  some  that  the  Epistle  of 
St.  James  is  apocryphal,  and  so  read  with  less  fear 
that  stabbing  truth,  that  in  company  with  this  vice 
thy  religion  is  in  vain.  Moses  broke  the  tables 
without  breaking  of  the  law ;  but  where  charity  is 
broke  the  law  itseh  is  shattered,  which  cannot  be 
whole  without  love,  which  is  the  fulfilling  of  it. 
Look  humbly  upon  thy  virtues ;  and  though  thou 
art  rich  in  some,  yet  think  thyself  poor  and  naked 
without  that  crowning  grace,  which  thinketh  no 
evil,  which  envieth  not,  which  beareth,  hopeth, 
beheveth,  endureth  all  things.  With  these  sure 
graces,  while  busy  tongues  are  crying  out  for  a  drop 


120  CHARITY   AND    FRATERNITY 

of  cold  water,  mutes  may  be  in  happiness,  and  sing 
the  Trisagion  in  heaven.'  ^^ 


The  honest  J  say  advisedly  an  honest  heart — the  honest  head 
is  prone  to  be  cold  and  stern,  given  to  judgement, 
not  mercy,  and  not  always  willing  to  entertain  that 
true  charity  which,  while  it  thinketh  no  evil,  is 
anxious  to  put  the  best  possible  interpretation  upon 
the  motives  of  a  fellow  worker.  It  will  foster,  too, 
an  attitude  of  generous,  friendly  rivalry  untinged 
by  the  green  peril,  jealousy,  that  is  the  best 
preventive  of  the  growth  of  a  bastard  scientific 
spirit — loving  seclusion  and  working  in  a  lock-and- 
key  laboratory,  as  timorous  of  light  as  is  a 
thief.  ^5 

Charity.  The  hardest  lesson  of  all  to  learn  is  that  the  law  of 
the  higher  life  is  only  fulfilled  by  love,  i.  e.  charity. 
Many  a  physician  whose  work  is  in  a  daily  round 
of  beneficence  will  say  hard  things  and  think  hard 
things  of  a  colleague.  No  sin  will  so  easily  beset 
you  as  uncharitableness  towards  your  brother 
practitioner.  So  strong  is  the  personal  element  in 
the  practice  of  medicine,  and  so  many  are  the 
wagging  tongues  in  every  parish,  that  evil-speaking, 
lying,  and  slandering  find  a  shining  mark  in  the 
lapses  and  mistakes  which  are  inevitable  in  our 
work.  There  is  no  reason  for  discord  and  disagree- 
ment, and  the  only  way  to  avoid  trouble  is  to  have 
two  plain  rules.  From  the  day  you  begin  practice 
never  under  any  circumstances  listen  to  a  tale  told 


IN    MEDICINE  121 

to  the  detriment  of  a  brother  practitioner.  And 
when  any  dispute  or  trouble  does  arise,  go  frankly, 
ere  sunset,  and  talk  the  matter  over,  in  which  way 
you  may  gain  a  brother  and  a  friend.  Very  easy 
to  carry  out,  you  may  think !  Far  from  it ;  there 
is  no  harder  battle  to  fight.  Theoretically  there 
seems  to  be  no  difiSculty,  but  when  the  concrete 
wound  is  rankling,  and  after  Mrs.  Jones  has  rubbed 
it  in  with  cayenne  pepper  by  declaring  that  Dr.  J. 
told  her  in  confidence  of  your  shocking  bungling, 
your  attitude  of  mind  is  that  you  would  rather  see 
him  in  purgatory  than  make  advances  towards 
reconciliation.  Wait  until  the  day  of  your  trial 
comes  and  then  remember  my  words.  '^ 

It  is  the  confounded  tales  of  patients  that  so  often  Tittle-tattle. 

set  us  by  the  ears,  but  if  a  man  makes  it  a  rule 

never  under  any  circumstances  to  believe  a  story 

told  by  a  patient  to   the  detriment  of  a  fellow 

practitioner,  even  if  he  thinks  it  to  be  true,  though 

the  measure  he  metes  may  not  be  measured  to  him 

again,  he  will  have  the  satisfaction  of  knowing  that 

he  has  closed  the  ears  of  his  soul  to  ninety-nine 

lies,  and  to  have  missed  the  hundredth  truth  will  not 

hurt  him.  '^ 

Women,  our  greatest  friends  and  our  greatest 
enemies,  are  the  chief  sinners ;  and  while  one  will 
exhaust  the  resources  of  the  language  in  describing 
our  mistakes  and  weaknesses,  another  will  laud  her 
pet  doctor  so  indiscriminately  that  all  others  come 
under  a  sort  of  oblique  condemnation.    Feminae 


122  CHARITY    AND    FRATERNITY 

suni  medtcorufJt  tubae  is  an  old  and  true  saying-. 
It  is  hard  to  say  whether,  as  a  whole,  we  do  not 
suffer  just  as  much  from  the  indiscriminate  praise. 
But  against  this  evil  we  are  helpless.  Far  other- 
wise, when  we  do  not  let  the  heard  word  die ;  not 
to  listen  is  best,  though  that  is  not  always  possible, 
but  silence  is  always  possible,  than  which  we  have 
no  better  weapon  in  our  armoury  against  evil- 
speaking-,  lying,  and  slandering.  The  bitterness  Is 
when  the  tale  Is  believed  and  a  brother's  good  name 
is  involved.  Then  begins  the  worst  form  of  ill- 
treatment  that  the  practitioner  receives,  and  at  his 
own  hands.  He  allows  the  demon  of  resentment 
to  take  possession  of  his  soul,  when  five  minutes' 
frank  conversation  might  have  gained  a  brother. 
In  a  small  or  large  community  what  more  joyful 
than  to  see  the  brethren  dwelling  together  In  unity  ? 
The  bitterness,  the  rancour,  the  personal  hostility 
which  many  of  us  remember  in  our  younger  days 
have  been  largely  replaced  by  a  better  feeling,  and 
while  the  golden  rule  is  not  always,  as  it  should  be, 
our  code  of  ethics,  we  have  certainly  become  more 
charitable  the  one  towards  the  other.  ^^ 

The  And  the  third  cause  of  uncharitableness  Is  the 

wagging  ^^^^gijjg  tongues  of  others  who  are  too  often  ready 
to  tell  tales  and  make  trouble  between  doctors. 
There  is  only  one  safe  rule,  never  listen  to  a  patient 
who  begins  with  a  story  about  the  carelessness  and 
inefficiency  of  Dr.  Blank.  Shut  him  or  her  up 
with  a  snap,  knowing  fuU  well  that  the  same  tale 
may  be  told  of  you  a  few  months  later.    Fully  half 


IN    MEDICINE  123 

of  the  quarrels  of  doctors  are  fomented  by  the  tittle- 
tattle  of  patients,  and  the  only  safeguard  is  not  to 
listen.  Sometimes  it  is  impossible  to  check  the 
flow  of  imprecation  and  slander,  and  then  apply 
the  other  rule — perfectly  safe,  and  one  which  may  be 
commended  as  a  good  practice — never  believe  what 
a  patient  tells  you  to  the  detriment  of  a  brother, 
even  though  you  may  think  it  to  be  true.  ^^ 

In  the  hospital,  we  learn  to  scan  gently  our  brother  Charity  of 
man,  judging  not,  asking  no  questions,  but  meting  *^®  hospitaL 
out  to  all  alike  a  hospitality  worthy  of  the  Hotel 
Dieuy  and  deeming  ourselves  honoured  in  being 
allowed  to  act  as  its  dispensers.  ''* 

In  the  hospital,  too,  are  daily  before  oiu"  eyes  the 
problems  which  have  ever  perplexed  the  human 
mind ;  problems  not  presented  in  the  dead  abstract 
of  books,  but  in  the  living  concrete  of  some  poor 
fellow  in  his  last  round,  fighting  a  brave  fight,  but 
sadly  weighed,  and  going  to  his  account  '  un- 
housel'd,  disappointed,  unanel'd,  no  reckoning 
made.'  ^* 

Among  the  ancients,  many  had  risen  to  the  idea  of  The  spirit 
forgiveness  of  enemies,  of  patience  under  wrong-  °^1°"^^- 
doing,  and  even  of  the  brotherhood  of  man ;  but 
the  spirit  of  Love  received  its  incarnation  only  with 
the  ever  memorable  reply  to  the  ever  memorable 
question,  Who  is  my  neighbour? — a  reply  which 
has  changed  the  attitude  of  the  world.  '* 


124 


CHARITY    AND    FRATERNITY 


Romola  the 
nurse. 


The  nurse. 


Dreams. 


Art  of  giv- 
ing. 


Romola,  the  student,  helping  her  blind  father,  and 
full  of  the  pride  of  learning,  we  admire ;  Romola, 
the  devotee,  carrying  in  her  withered  heart  woman's 
heaviest  disappointment,  we  pity;  Romola,  the 
nurse,  doing  noble  deeds  amid  the  pestilence,  rescu- 
ing those  who  were  ready  to  perish,  we  love.  '^ 

o^         .  .  .     ^ 

There  Is  no  higher  mission  In  this  life  than  nursing 

God's  poor.     In  so  doing  a  woman  may  not  reach 

the  ideals  of  her  soul ;  she  may  fall  far  short  of  the 

ideals  of  her  head,  but  she  will  go  far  to  satiate  the 

longings  of  the  heart  from  which  no  woman  can 

escape.  ^^ 

lb  each  one  of  us  at  some  time,  I  suppose,  has 
come  the  blessed  impulse  to  break  away  from  all 
such  ties  and  follow  cherished  Ideals.  Too  often  it 
is  but  a  flash  of  youth,  which  darkens  down  with 
the  growing  years.  Though  the  dream  may  never 
be  realized,  the  impulse  will  not  have  been  wholly 
in  vain  if  it  enables  us  to  look  with  sympathy  upon 
the  more  successful  efforts  of  others.  ^^ 

May  I  say  a  word  on  the  art  of  giving  ?  The 
essence  Is  contained  in  the  well-known  sentence : — 
*  Let  every  man  do  according  as  he  is  disposed  in 
his  heart,  not  grudgingly,  or  of  necessity.'  Sub- 
scriptions to  a  cause  which  is  for  the  benefit  of  the 
entire  profession  should  truly  be  given  as  a  man 
is  disposed  in  his  heart,  not  in  his  pocket,  and 
assuredly  not  of  necessity,  but  as  a  duty,  even 
as  a  privilege,  and  as  a  pleasure.  With  the  young 
among  you  the  days  of  travail  and  distress  are  not 


IN    MEDICINE  125 

yet  over,  and  to  give  would  be  wrong-.  It  is 
sufficient  for  such  to  have  the  wish ;  the  elder  brothers 
will  bear  your  share  ;  only  be  sure  to  foster  those 
generous  impulses,  which  are  apt  to  be  intense  in 
direct  proportion  to  the  emptiness  of  the  purse.  ^° 

Beyond  a  modest  competency  the  sensible  doctor 
does  not  aspire,  but  in  the  profession  of  every  state 
there  is  a  third  group,  composed  of  a  few  men,  who, 
dry-nursed  by  us,  sometimes  by  the  public,  have 
become  prosperous,  perhaps  wealthy.  Freely  they 
have  received,  freely  they  should  give.  It  must  be 
acknowledged,  however,  that  the  admonition  of 
Sir  Thomas  Browne, '  should  your  riches  increase, 
let  your  mind  keep  pace  with  them,'  is  not  always 
regarded  by  them.  There  has  been  a  good  deal  in 
the  papers  lately  about  the  large  fortunes  left  by 
doctors;  but  it  has  not  been  a  pleasant  feature 
to  note,  with  scarcely  an  exception,  either  an  entire 
neglect  or  a  very  beggarly  remembrance  of  the 
profession  in  which  these  men  had  at  any  rate  laid 
the  foundation  of  their  large  fortunes. '° 

In  conclusion,  may  I  paraphrase  those  noble  words 
of  Aristode,  in  which  he  laid  down  the  duty  of 
the  citizen  to  the  state,  as  also  peculiarly  appro- 
priate in  defining  the  obligations  of  the  doctor 
to  his  calling  ?  No  physician  has  a  right  to  consider 
himself  as  belonging  to  himself;  but  all  ought  to 
regard  themselves  as  belonging  to  the  profession,  in- 
asmuch as  each  is  a  part  of  the  profession  ;  and  care 
for  the  part  naturally  looks  to  care  for  the  whole. '° 


MEDICAL  EDUCATION 

The  Teacher 
The  Student 
The  University 
The  Hospital 


THE  SEARCHER  FOR  KNOWLEDGE 

« He  who  knows  not,  and  knows  not  that  he  knows  not, 
is  a  fool.    Shun  him. 

He  who  knows  not,  and  knows  that  he  knows  not,  is 
simple.    Teach  him.'    (Arabian  proverb.) 


I^ 


MEDICAL   EDUCATION 


Education : 
what  it  is. 


Education. 


What,  after  all,  is  education  but  a  subtle,  slowly- 
affected  change,  due  to  the  action  of  the  externals 
— of  the  written  record  of  the  great  minds  of  all 
ages,  of  the  beautiful  and  harmonious  surroundings 
of  nature  and  of  art,  and  of  the  lives,  good  or  ill, 
of  our  fellows  ? — these  alone  educate  us,  these  alone 
mould  the  growing  mind.  ^' 

The  complex,  varied  influences  of  art,  of  science, 
and  of  charity ;  of  art,  the  highest  development  of 
which  can  come  only  with  that  sustaining  love  for 
ideals  which  'burns  bright  or  dim  as  each  are 
mirrors  of  the  fire  for  which  all  thirst ' ;  of  science, 
the  cold  logic  of  which  keeps  the  mind  independent 
and  free  from  the  toils  of  self-deception  and  half- 
knowledge  ;  of  charity,  in  which  we  of  the  medical 
profession,  to  walk  worthily,  must  live  and  move 
and  have  our  being.  " 

At  the  outset  appreciate  clearly  the  aims  and 
objects  each  one  of  you  should  have  in  view — a 
knowledge  of  disease  and  its  cure,  and  a  knowledge 
of  yourself.  The  one,  special  education,  will  make 
you  a  practitioner  of  medicine ;  the  other,  an  inner 
education,  that  may  make  you  a  truly  good  man, 
four-square  and  without  a  flaw.  The  one  is  ex- 
trinsic and  is  largely  accomplished  by  teacher  and 
tutor,  by  text  and  by  tongue;  the  other  is  in- 
trinsic and  is  the  mental  salvation  to  be  wrought 
out  by  each  one  for  himself.  The  first  may  be 
had  without  the  second ;  any  one  of  you  may 
become  an  active  practitioner,  without  ever  having 


MEDICAL    EDUCATION 

sense  enough  to  realize  that  through  life  you  have^ 
been  a  fool ;  or  you  may  have  the  second  without 
the  first,  and  without  knowing  much  of  the  art, 
you  may  have  the  endowments  of  head  and  heart 
that  make  the  little  you  do  possess  go  very  far  in 
the  community.  What  I  hope  to  infect  you  with 
is  a  desire  to  have  a  due  proportion  of  each.  ^* 

Some  will  tell  you  that  the  profession  is  under-  What  the 
rated,  unhonoured,  underpaid,  its  members  social  profession  is. 
drudges — the  very  last  profession  they  would  re- 
commend a  young  man  to  take  up.  Listen  not  to 
these  croakers;  there  are  such  in  every  calhng, 
and  the  secret  of  their  discontent  is  not  hard  to 
discover.  The  evils  which  they  deprecate,  and 
ascribe — it  is  dijQScult  to  say  to  whom — in  themselves 
lie ;  evils,  the  seeds  of  which  were  sown  when  they 
were  as  you  are  now  (students) ;  sown  in  hours  of 
idleness,  in  inattention  to  studies,  in  consequent 
failure  to  grasp  those  principles  of  their  science 
without  which  the  practice  of  medicine  does  indeed 
become  a  drudgery,  for  it  degenerates  into  a  busi- 
ness. I  would  rather  tell  you  of  a  profession 
honoured  above  all  others ;  one  which,  while 
calling  forth  the  highest  powers  of  the  mind,  brings 
you  into  such  warm  personal  contact  with  your 
fellow  men  that  the  heart  and  sympathies  of  the 
coldest  nature  must  needs  be  enlarged  thereby. 
For,  consider  the  practical  outcome  of  all  you 
gather  ;  the  active  work  for  which  your  four  years' 
study  is  a  preparation.  Will  not  your  whole 
energies    be  spent   in   befriending  the    sick  and 

K 


139  MEDICAL    EDUCATION 

suffering-  ?  in  helping  those  who  cannot  help  them- 
selves ?  in  rescuing  valuable  lives  from  the  clutch 
of  grim  death  ?  in  cheering  the  loving  nurses  of  the 
sick,  who  often  hang  upon  your  words  with  a  most 
touching  trust  ?  Aye !  and  in  lessening  the  sad  sura 
of  human  misery  and  pain  by  spreading,  so  far  as 
in  you  lies,  the  knowledge  of  those  grand  laws  of 
health  transgressed  so  ignorantly  and  yet  avenged 
so  fatally  ?  ^^ 

The  Except  it  be  a  lover,  no  one  is  more  interesting 

student :  ^  ^jj  object  of  study  than  a  student.  Shakespeare 
might  have  made  him  a  fourth  in  his  immortal 
group.  The  lunatic  with  his  fixed  idea,  the  poet 
with  his  fine  frenzy,  the  lover  with  his  frantic 
idolatry,  and  the  student  aflame  with  the  desire  for 
knowledge  are  of  '  imagination  all  compact.'  To 
an  absorbing  passion,  a  whole-souled  devotion, 
must  be  joined  an  enduring  energy,  if  the  student 
is  to  become  a  devotee  of  the  grey-eyed  goddess 
to  whose  law  his  services  are  bound.  Like  the 
quest  of  the  Holy  Grail,  the  quest  of  Minerva  is 
not  for  all.  For  the  one,  the  pure  life;  for  the 
other,  what  Milton  calls  '  a  strong  propensity  of 
nature.'  Here  again  the  student  often  resembles 
the  poet — he  is  born,  not  made.  While  the  resultant 
of  two  moulding  forces,  the  accidental,  external 
conditions,  and  the  hidden,  germinal  energies, 
which  produce  in  each  one  of  us  national,  family, 
and  individual  traits,  the  true  student  possesses  in 
some  measure  a  divine  spark  which  sets  at  naught 
their  laws.  .  .  .  There  are  three  unmistakable  signs 


MEDICAL    EDUCATION  I3I 

by  which  you  may  recognize  him  ...  an  absorbing-  how  you 
desire  to  know  the  truth,  an  unswerving  steadfast-  niay  know 
ness  in  its  pursuit,  and  an  open,  honest  heart,  free 
from  suspicion,  guile,  and  jealousy.  ^^ 

A  word  or  two  on  method  in  study,  though  it  is  Method  in 
not  an  easy  matter  to  discuss,  for  the  very  good  study, 
reason  that  there  is  no  one  method  suitable  to  all 
alike.     Who  will  venture  to  settle  upon  so  simple 
a  matter  as  the  best  time  for  work  }  .  .  .  The  other  The  time  for 
day   I    asked    Edward    Martin,    the    well-known  study, 
story-writer,  what  time  he  found  best  for  work. 
'  Not  in  the  evening,  and  never  between  meals ! ' 
was  his  answer,  which  may  appeal  to  some  of  my 
hearers.  .  .  .  Outside  of  the  asylum  there  are  also  Two  types 
the  two  great  types,  the  student-lark  who  loves  to  of  student, 
see  the  sun  rise,  who  comes  to  breakfast  with  a 
cheerful  morning  face  and  in  hilarious  spirits — two 
hours  of  work  and  half  an  hour's  exercise  before 
breakfast,  never  so  '  fit '  as  at  6  a.m. !    We  all  know 
the  type.     What  a  contrast  to  the  student-owl  with 
his  saturnine  morning  face,  thoroughly  unhappy, 
cheated  by  the  wretched  breakfast-bell  of  the  two 
best  hours  of  the  day  for  sleep,  no  appetite,  and 
permeated  with  an   unspeakable    hostility  to   his 
vis-a-vis^    whose    morning    garrulity    and    good 
humour   are  equally  offensive.     Only   gradually, 
as  the  day  wears  on  and  his  temperature  reaches 
98-2°,  does  he  become  endurable  to  himself  and  to 
others.     But  see  him   really  awake  at   10  p.m.! 
While  the  plethoric  lark  is  in  hopeless  coma  over 
his  books,  from  which  it  is  hard  to  rouse  him  suffi- 
K  2 


132 


MEDICAL   EDUCATION 


Vt 


Mind- 
raining. 


Concentra- 
tion and 
thorougb- 


ciently  to  get  his  boots  off  for  bed,  our  lean  owl- 
friend,  Saturn  no  longer  in  the  ascendant,  with 
bright  eyes  and  cheery  face,  is  ready  for  four  hours 
of  anything  you  wish — deep  study,  or 

'  Heart  affluence  in  discoursive  talk,' 

and  by  2  a.m.  he  will  undertake  to  unsphere  the 
spirit  of  Plato.  In  neither  a  virtue,  in  neither  a 
fault ;  we  must  recognize  these  two  types  of 
students,  differently  constituted  owing  possibly — 
though  I  have  but  little  evidence  for  the  belief — to 
thermal  peculiarities.  ^^ 

Get  accustomed  to  test  all  sorts  of  book  problems 
and  statements  for  yourself,  and  take  as  litde  as 
P possible  on  trust.  The  Hunterian  'Do  not  think, 
but  try '  attitude  of  mind  is  the  important  one  to 
cultivate.  The  question  came  up  one  day,  when 
discussing  the  grooves  left  on  the  nails  after  fever, 
how  long  it  took  for  the  nail  to  grow  out,  from 
root  to  edge.  A  majority  of  the  class  had  no 
further  interest ;  a  few  looked  it  up  in  books ;  two 
men  marked  their  nails  at  the  root  with  nitrate  of 
silver,  and  a  few  months  later  had  positive  know- 
ledge on  the  subject.  They  showed  the  proper 
spirit.  *^  ^ 

Men  will  not  take  time  to  get  to  the  heart  of 
a  matter.  After  all,  concentration  is  the  price  the 
modern  student  pays  for  success.  Thoroughness 
is  the  most  difficult  habit  to  acquire,  but  it  is  the 
pearl  of  great  price,  worth  all  the  worry  and  trouble 


MEDICAL    EDUCATION 


^ 


of  the  search.     The  dilettante  lives  an  easy,  butter-  The 
fly  life,  knowing  nothing  of  the  toil  and  labour  dilettante, 
with  which  the  treasures  of  knowledge  are  dug  out 
of  the  past,  or  wrung  by  patient  research  in  the 
laboratories.  *^ 

I  have  always  been  much  impressed  by  the  advice  Isolation, 
of  St.  Chrysostom :  '  Depart  from  the  highway  and 
transplant  thyself  in  some  enclosed  ground,  for  it 
is  hard  for  a  tree  which  stands  by  the  wayside  to 
keep  her  fruit  till  it  be  ripe.'  *^ 

Concentration  has  its  drawbacks.     It  is   possible  Concentra- 

to   become  so  absorbed   in   the  problem  of  the  ^°°'  ^^^,       / 

drawbacks.   / 
'enclitic   8e,'  or  the  structure  of  the  flagella  of 

the  Trichomonas,  or  of  the  toes  of  the  prehistoric 
horse,  that  the  student  loses  the  sense  of  proportion 
in  his  work,  and  even  wastes  a  lifetime  in  researches 
which  are  valueless  because  not  in  touch  with  cur- 
rent knowledge.  You  remember  poor  Casaubon, 
in  Middlemarch^  whose  painful  scholarship  was 
lost  on  this  account.  The  best  preventive  to  this  Get  de- 
is  to  get  denationalized  early.  The  true  student  nationalize 
is  a  citizen  of  the  world,  the  allegiance  of  whose 
soul,  at  any  rate,  is  too  precious  to  be  restricted 
to  a  single  country.  The  great  minds,  the  great 
works,  transcend  all  limitations  of  time,  of  lan- 
goiage,  and  of  race,  and  the  scholar  can  never  feel 
initiated  into  the  company  of  the  elect  until  he  can 
approach  all  of  life's  problems  from  the  cosmo- 
politan standpoint. ''5 


134 


MEDICAL    EDUCATION 


The  self-        A  serious  drawback  in  the  student  life  is  the  self- 

studeS"^  consciousness,  bred  of  too  close  devotion  to  books. 
A  man  gets  shy, '  dysopic,'  as  old  Timothy  Bright 
calls  it,  and  shuns  the  looks  of  men,  and  blushes 
like  a  girl.  The  strength  of  a  student  of  men  is  to 
travel — to  study  men,  their  habits,  character,  mode 
of  life,  their  behaviour  under  varied  conditions,  their 

Study  men.  vices,  virtues,  and  peculiarities.  Begin  with  a  care- 
ful observation  of  your  fellow  students  and  of  your 
teachers ;  then,  every  patient  you  see  is  a  lesson  in 
much  more  than  the  malady  from  which  he  suffers. 
Mix  as  much  as  you  possibly  can  with  the  outside 
world,  and  learn  its  ways.  The  student  societies, 
the  students'  union,  the  gymnasium,  and  the  out- 
side social  circle  should  be  cultivated  systemati- 
cally, to  enable  you  to  conquer  the  diffidence 
which  goes  with  bookishness  and  which  wiU  prove 
a  very  serious  drawback  in  after-life.  I  cannot  too 
strongly  impress  upon  the  earnest  and  attentive 
men  among  you  the  necessity  of  overcoming  this 
unfortunate  failing  in  your  student  days.  It  is  not 
easy  for  every  one  to  reach  a  happy  medium,  and 
the  distinction   between  a  proper  self-confidence 

♦  Cheek.'  and  '  cheek,'  particularly  in  junior  students,  is  not 
always  to  be  made.  The  latter  is  met  with 
chiefly  among  the  student  pilgrims  who,  in  travel- 
ling down  the  Delectable  Mountains,  have  gone 
astray  and  have  passed  to  the  left  hand,  where 
lieth  the  country  of  Conceit,  the  country  in 
which  you  remember  the  brisk  lad  Ignorance  met 
Christian.  *^ 


MEDICAL    EDUCATION  I35 

Two  letters  from  Louis  to  James  Jackson,  Sr,,  show  The  waiting 
how  important  he  thought  a  prolonged  period  of  Y®^^- 
study  was  for  a  young  man.     He  says : — 

'  I  pointed  out  to  him  (James  Jackson,  Jr.)  the 
advantage  it  would  be  for  science  and  for  himself  if 
he  would  devote  several  years  exclusively  to  the 
observation  of  diseases.  I  now  retain  the  same 
opinion  and  am  strengthened  in  it ;  for  the  more 
I  become  acquainted  with,  and  the  more  I  notice 
him  applying  himself  to  observation,  the  more  I  am 
persuaded  that  he  is  fitted  to  render  real  service  to 
science,  to  promote  its  progress.  I  find  that  he 
would  be  well  pleased  to  follow  for  a  certain  period 
the  vocation  for  which  nature  has  fitted  him;  but 
he  has  stated  to  me  that  there  are  many  difficulties 
which  would  prevent  his  devoting  himself  exclusively 
to  observation  for  several  years.  But  can  these 
difficulties  be  insurmountable  ?  ' 

And  again  : — • 

'  Let  us  suppose  that  he  should  pass  four  more 
years  without  engaging  in  the  practice  of  medicine, 
what  a  mass  of  positive  knowledge  will  he  have 
acquired !  How  many  important  results  will  he 
have  been  able  to  publish  to  the  world  during  that 
period !  After  that  he  must  necessarily  become  one 
of  the  bright  lights  of  his  country ;  others  will 
resort  to  him  for  instruction,  and  he  will  be  able  to 
impart  it  with  distinguished  honour  to  himself.  If 
all  things  be  duly  weighed,  it  will  appear  that  he 
will  soon  redeem  the  four  years,  which  men  of 
superficial  views  will  beheve  him  to  have  lost.' 

In  another  letter,  the  following  year,  just  before 
young  Jackson's  departure  from  Paris,  he  refers 
again  to  this  question,  and  urges  Dr.  Jackson  to 
allow   his  son   to  devote    himself   exclusively  to 


'Laws  of 
nature  must 
be  dis- 
covered, not 
invented.' 
(Louis.) 


Thorough 
regard  for 
truth  and 
elevation 
of  mind 
essentials  to 
the  accurate 
observer  of 
disease. 


13^  MEDICAL    EDUCATION 

oBservation  for  several  years  in  Boston.  The  extract 
from  this  letter  is  worth  quoting- : — 

'Think  for  a  moment,  sir,  of  the  situation  in  which 
we  physicians  are  placed.  We  have  no  legislative 
chambers  to  enact  laws  for  us.  We  are  our  own 
lawgivers ;  or  rather,  we  must  discover  the  laws  on 
which  our  profession  rests.  We  must  discover 
them  and  not  invent  them ;  for  the  laws  of  nature 
are  not  to  be  invented.  And  who  is  to  discover 
these  laws  ?  Who  should  be  a  diligent  observer  of, 
nature  for  this  purpose,  if  not  the  son  of  a  physician, 
who  has  himself  experienced  the  difficulties  of  the 
observation  of  disease,  who  knows  how  few  minds 
are  fitted  for  it,  and  how  few  have  at  once  the  talents 
and  inclination  requisite  for  the  task  ?  The  inclina- 
tion especially,  for  this  requires  that  the  observer 
should  possess  a  thorough  regard  for  truth,  and 
a  certain  elevation  of  mind,  or  rather  of  character, 
which  we  rarely  meet  with.  All  this  is  united  in 
your  son.  You  ought — for  in  my  opinion  it  is 
a  duty — you  ought  to  consecrate  him  for  a  few 
years  to  science.  This,  sir,  is  my  conviction,  and 
I  hope  it  will  be  yours  also.  I  know  very  well  that 
every  one  will  not  be  of  the  same  opinion ;  but 
what  matters  it,  if  it  be  yours  1 — if  you  look  upon 
a  physician,  as  I  do,  as  holding  a  sacred  office, 
which  demands  greater  sacrifices  than  are  to  be 
made  in  any  other  profession  ? '  ^ 


Louis  and 

Andral 

compared. 


In  one  of  his  (W.  W.  Gerhard)  letters  to  his  brother, 
dated  January  18,  1832,  he  says: — 

'  Dr.  Louis  is  delivering-  an  interesting  clinic  at 
La  Pitie ;  he  is  a  remarkable  man,  very  different 
from  the  physicians  of  England  or  America,  and 
remarkable  even  at  Paris  by  the  strict  mathe- 
matical accuracy  with  which    he    arrives  at  his 


MEDICAL    EDUCATION 


^ 


results  ;  he  is  not  a  brilliant  man,  not  of  the  same 
grade  of  intellect  as  his  colleague  at  La  Pitie, 
Andrai; 

In  another  letter  he  gives  an  account   of  his 
day's  work: — 

'The   morning  from  seven  to  ten  is  occupied  A  medical 
with  the  visit  and  clinic  at  the  hospital ;  there  are  student's 
several  distinct  clinics  now  in  actual  progress ;  each  ^y  ^*  ^^ 
of  them  has  its  advantages.     I  shall  vary  my  at-  gc^^jintije 
tendance  at  the  various  hospitals,  and  select  those  tiiirties. 
lecturers  who  are  of  real  merit.     At  this  moment 
we  are  following  Piorry  at  the  Salpetriere,  a  very 
distant  hospital,  two  or  three  miles  from  our  lodg- 
ings ;    his   patients   are  all   old  women,   and   not 
interesting.     My  object  in  following  his  course  is 
to  obtain  some  interesting  information  on  the  best 
mode   of  investigating  the   diseases  of  the  chest. 
M.  Piorry  has   devoted  special   attention   to   this 
subject.     From  Salpetriere  we  hurry  to  La  Pitie ; 
we  hear  a  surgical  lecture,  reach  home  to  break- 
fast, and   then   to   the  school  of  medicine.     The 
lectures   at   the  school,  with  a  private  course   of 
anatomy  during  the  hour  of  intermission,  fill  up 
the  remainder  of  the  day  until  four.     Fortunately 
a  private  clinic  at  La  Charite  introduces  me  to  a 
set  of  very  interesting  cases,  especially  on  pectoral 
cases.     Dr.  Dagneau  has  a  class  who  pay  him  ten 
francs  a  month,  and  enjoy  the  privilege  of  examin- 
ing the  patients  much  more  conveniently  than  is 
practicable  during  the  morning  visit  in  the  midst 
of  a  crowd  of  students.     We   dine  at  5.30,  and  The  delights 
then  lectures  again  until  eight  o'clock.     Imagine  of  positive 
the  facilities,  the  delightful  advantage  of  acquiring  ^2^^°^ 
positive  information,  and  what  is  at  least  as  im-  learning  the 
portant,  of  learning  the  mode  of  obtaining  these  methods  of 
positive  results.     We  see  and  hear  the  men  who  acquiring 
are  so  well  known  to  us  in  America,  learn  to  form  these. 


Relation  of 
teacher  to 
student. 


■H 


MEDICAL    EDUCATION 


a  correct  estimate  of  their  relative  worth — in  short, 
one  of  the  most  striking  advantages  of  a  medical 
visit  to  Europe  is  to  acquire  the  sort  of  liberal 
professional  feeling  which  is  rarely  secured  by  the 
continued  intercourse  with  the  same  men,  and  the 
unpleasant  medical  politics  which  divide  the  pro- 
fession in  America.' ^° 

A  fraternal  attitude  is  not  easy  to  cultivate — the 
chasm  between  the  chair  and  the  bench  is  difficult 
to  bridge.  Two  things  have  helped  to  put  up 
a  cantilever  across  the  gulf.  The  successful  teacher 
is  no  longer  on  a  height,  pumping  knowledge  at 
high  pressure  into  passive  receptacles.  The  new 
methods  have  changed  all  this.  He  is  no  longer 
Sir  Oracle^  perhaps  unconsciously  by  his  very 
manner  antagonizing  minds  to  whose  level  he  can- 
not possibly  descend,  but  he  is  a  senior  student 
anxious  to  help  his  juniors.  When  a  simple, 
earnest  spirit  animates  a  college,  there  is  no  ap- 
preciable interval  between  the  teacher  and  the 
taught — both  are  in  the  same  class,  the  one  a  little 
more  advanced  than  the  other.  So  animated,  the 
student  feels  that  he  has  joined  a  family  whose 
honour  is  his  honour,  whose  welfare  is  his  own,  and 
whose  interests  should  be  his  first  consideration.  ""^ 


Teachers 
J    and 
teaching. 


The  phenomenal  strides  in  every  branch  of  scientific 
medicine  have  tended  to  overload  it  with  detail. 
To  winnow  the  wheat  from  the  chaff  and  to  pre- 
pare it  in  an  easily  digested  shape  for  the  tender 
stomachs  of  the  first-  and  second-year  students 
taxes  the  resources  of  the  most  capable  teacher.  '^\ 


MEDICAL    EDUCATION 


^9 


The  devotion  to  a  subject,  and  the  enthusiasm 
and  energy  which  enable  a  man  to  keep  abreast 
with  its  progress,  are  the  very  qualities  which  often 
lead  him  into  pedagogic  excesses.  To  reach  a 
right  judgement  in  these  matters  is  not  easy,  and 
after  all  it  may  be  said  of  teaching  as  Izaak  Walton 
says  of  angling :  '  Men  are  to  be  born  so,  I  mean 
with  inclinations  to  it.'  '^ 

Professors  may  be  divided  into  four  classes.  There  Four  classes 
is,  first,  the  man  who  can  think,  but  who  has  neither  of  teachers, 
tongue  nor  technique.  Though  useless  for  the 
ordinary  student,  he  may  be  the  leaven  of  a 
faculty  and  the  chief  glory  of  his  University. 
A  second  variety  is  the  phonographic  professor, 
who  can  talk,  but  who  can  neither  think  nor  work. 
Under  the  old  regime  he  repeated  year  by  year 
the  same  lecture.  A  third  is  the  man  who  has 
technique,  but  who  can  neither  talk  nor  think ;  and 
a  fourth  is  the  rare  professor  who  can  do  all  three, 
think,  talk,  and  work.  '^ 

(   For  the  crass  therapeutic  credulity,  so  widespread  Scepticism,  "^ 
]  to-day,  and  upon  which  our  manufacturing  chemists  ^^^^^  °** 
/  wax  fat,  there  is  no  more  potent  antidote  than  the 
I  healthy  scepticism  bred  of  long  study  in  the  post- 
Vdortem  room.  '^ 

Routine,  killing  routine,  saps  the  vitality  of  many  Killing 
teachers  who  start  with  high  aims,  and  who,  for  '"O'ltine. 
years,  strive   with  all  their  energies  against  the 
degeneration  which  it  is  so  prone  to  entail.     In 


-L 


Sense  of 
responsi- 
bility and 
proportion. 


The  class 
always  first. 


w 


MEDICAL    EDUCATION 


The  true 
greatness  of 
a  school. 


the  smaller  schools  isolation,  the  absence  of  con- 
genial spirits  working  at  the  same  subject,  favours 
stagnation,  and  after  a  few  years  the  fires  of  early 
enthusiasm  no  longer  glow  in  the  perfunctory 
lectures.  In  many  teachers  the  ever-increasing 
demands  of  practice  leave  less  and  less  time  for 
study,  and  a  first-class  man  may  lose  touch  with 
his  subject  through  no  fault  of  his  own,  but 
through  an  entanglement  in  outside  affairs  which 
he  cannot  control,  yet  deeply  regrets.  To  his 
five  natural  senses  the  student-teacher  must  add 
two  more — the  sense  of  responsibility  and  the 
sense  of  proportion.  Most  of  us  start  with  a 
highly  developed  sense  of  the  importance  of  the 
work,  and  with  a  desire  to  live  up  to  the  respon- 
sibilities entrusted  to  us.  Punctuality,  the  class 
first,  always  and  at  all  times;  the  best  that  a  man 
has  in  him,  nothing  less;  the  best  the  profession 
has  on  the  subject,  nothing  less;  fresh  energies 
and  enthusiasm  in  dealing  with  dry  details ;  ani- 
mated, unselfish  devotion  to  all  alike ;  tender  con- 
sideration for  his  assistants — these  are  some  of 
the  fruits  of  a  keen  sense  of  responsibility  in 
a  good  teacher.  The  sense  of  proportion  is  not 
so  easy  to  acquire,  and  much  depends  on  the 
training  and  on  the  natural  disposition.'^^ 

The  past  is  always  with  us,  never  to  be  escaped ; 
it  alone  is  enduring;  but,  amidst  the  changes  and 
chances  which  succeed  one  another  so  rapidly  in 
this  life,  we  are  apt  to  live  too  much  for  the 
present  and  too  much  in  the  future.  ^° 


MEDICAL    EDUCATION 


k 


The  great  possession  of  any  University  is  its 
great  names.  It  is  not  the  '  pride,  pomp,  and  cir- 
cumstance '  of  an  institution  which  bring  honour ; 
not  its  wealth,  nor  the  number  of  its  schools ;  not 
the  students  who  throng  its  halls,  but  the  men 
who  have  trodden  in  its  service  the  thorny  road 
through  toil,  even  through  hate,  to  the  serene 
abode  of  Fame,  climbing  'like  stars  to  their 
appointed   height.'^" 

But  it  is  a  secondary  matter,  after  all,  whether  Man  the 

a  school  is  under   State    or  University   control,  measure  of 

tiifi  school* 
whether  the  endowments  are  great  or  small,  the 

equipments  palatial  or  humble ;  the  fate  of  an  in- 
stitution rests  not  on  these ;  the  inherent,  vital  ele- 
ment, which  transcends  all  material  interests,  which 
may  give  to  a  school  glory  and  renown  in  their 
absence,  and  lacking  which,  all  the  'pride,  pomp, 
and  circumstance  '  are  vain — this  vitalizing  element, 
I  say,  lies  in  the  men  who  work  in  its  halls,  and 
in  the  ideals  which  they  cherish  and  teach.  ^' 

There  is  no  more  potent  antidote  to  the  corroding  Value  of 
influence  of  mammon  than  the  presence  in  a  com-  sdentific 
munity  of  a  body  of  men  devoted  to  science,  living 
for  investigation  and  caring  nothing  for  the  lust  of 
the  eyes  and  the  pride  of  life.  ■"' 

We  forget  that  the  measure  of  the  value  of 
a  nation  to  the  world  is  neither  the  bushel  nor 
the  barrel,  but  fn.ind\  and  that  wheat  and  pork, 
though  useful   and   necessary,  are   but  dross   in 


^h^  MEDICAL   EDUCATION 

comparison  with  those  intellectual  products  which 
alone  are  imperishable. " 

Edacaticn,     The  hardest  comnction  to  get  into  the  mind  of 

a  life  course,  g.  beginner  is  that  the  education  upon  which  he  is 

engaged  is   not  a  college  course,  not  a  medical 

course,  but  a  Ufe  course,  ending  only  with  death, 

for  which  the  work  of  a  few  years  under  teachers 

is  but  a  preparation.     Whether  you  wiU  felter  and 

fail  in  the  race  or  whether  you  will  be  faithful  to  the 

end  depends  on  the  training  before  the  start,  and 

on  your  staying  f)Owers,  points  upon  which  I  need 

Student  and  not  enlarge.     You  can  all  become  good  students, 

gemus.  g  £-g^  jjjgy  become  great  students,  and  now  and 

again  one  of  you  will  be  found  who  does  easily 

^^and  well  what  others  cannot  do  at  aU,  or  very 

badly,  which  is  John  Ferriar's  excellent  definition 

of  a  genius.  *^ 

The  art—  The  best  that  is  known  and  taught  in  the  world — 
nothing  less  can  satisfy  a  teacher  worthy  of  the 
name,  and  upon  us  of  the  medical  faculties  lies 
a  bounden  duty  in  this  respect,  since  our  art,  co- 
ordinate with  human  suffering,  is  cosmopoUtan.  " 

The  good       The  aim   of  a  school  should  be  to  have  these 
^^*^*^*  departments  in  the  charge  of  men  who  have,  first, 

enihtisiasffi^  that  deep  love  of  a  subject,  that  desire 
to  teach  and  extend  it  without  which  all  instruction 
becomes  cold  and  hfeless ;  secondly,  a  full  and 
personal  knowledge  of  the  branch  taught  \  not 
a  second-hand  information  derived  from  books,  but 


MEDICAL    EDUCATION  1^ 

the  living  experience  derived  from  experimental 
and  practical  work  in  the  best  laboratories.  ^^ 

Men  are  required  who  have  a  sense  of  obligatiofiy 
that  feeling  which  impels  a  teacher  to  be  also  a^t^ 
contributor,  and  to  add  to  the  stores  from  which 
he  so  freely  draws.  ^"^ 

The  investigator,  to  be  successful,  must  start 
abreast  of  the  knowledge  of  the  day,  and  he  differs 
from  the  teacher,  who  living  in  the  present,  ex-  ?^ 
pounds  only  what  is  current,  in  that  his  thoughts 
must  be  in  the  future,  and  his  ways  and  work  in 
advance  of  the  day  in  which  he  lives.  ^^ 

The  same  obligation  rests  on  him  to  know  and 
to  teach  the  best  that  is  known  and  taught  in  the 
world:  on  the  surgeon,  the  obHgation  to  know 
thoroughly  the  scientific  principles  on  which  his 
art  is  based,  to  be  a  master  in  the  technique  of 
his  handicraft,  ever  studying,  modifying,  improv- 
ing; on  the  physician,  the  obligation  to  study 
the  natural  history  of  diseases,  and  the  means  for 
their  prevention,  to  know  the  true  value  of  regimen, 
diet,  and  drugs  in  their  treatment,  ever  testing, 
devising,  thinking; — and  upon  both,  to  teach  to 
their  students  habits  of  reliance,  and  to  be  to  them 
examples  of  gentleness,  forbearance,  and  courtesy 
in  dealing  with  their  suffering  brethren. "" 

There  is  a  great  need  in  the  colleges  of  this  country  Thinkers, 
of  men  who  are  thinkers  as  well  as  workers — men 


144  MEDICAL    EDUCATION 

with  ideas;  men  who  have  drunk  deep  of  the 
astral  wine,  and  whose  energies  are  not  sapped 
in  the  treadmill  of  the  class-room. " 

Thinking—    The  other  function  of  a  University  is   to  think. 

a  University  Xeaching  current  knowledge  in  all  departments; 
teaching  the  steps  by  which  the  status  praesens 
has  been  reached,  and  teaching  how  to  teach,  from 
the  routine  work  of  the  various  college  faculties.  ^^ 

What  I  mean  by  the  thinking  function  of  a 
University,  is  that  duty  which  the  professional 
corps  owes  to  enlarge  the  boundaries  of  human 
knowledge.  Work  of  this  sort  makes  a  University 
great,  and  alone  enables  it  to  exercise  a  wide 
influence  on  the  minds  of  men."^ 

The  very  best  instructor  for  students  may  have 
no  conception  of  the  higher  lines  of  work  in  his 
branch,  and  contrariwise,  how  many  brilliant  in- 
vestigators have  been  wretched  teachers !  '^^ 

In  a  school  which  wishes  to  do  thinking  as  well 
as  teaching,  men  must  be  selected  who  are  not  only 
thoroughly  au  courant  with  the  best  work  in  their 
department  the  world  over,  but  who  also  have  ideas, 
with  ambition  and  energy  to  put  them  into  force — 
men  who  can  add,  each  one  in  his  sphere,  to  the 
store  of  the  world's  knowledge.  Men  of  this  stamp 
alone  confer  greatness  upon  a  University.  They 
should  be  sought  for  far  and  wide ;  an  institution 
which  wraps  itself  in  Strabo's  cloak  and  does  not 


MEDICAL    EDUCATION  I45 

look  beyond  the  college  gates  in  selecting  professors 
may  get  good  teachers,  but  rarely  good  thinkers.  ^^ 

Surrounded  by  a  group  of  bright  young  minds, 
well  trained  in  advanced  methods,  not  only  is  the 
professor  himself  stimulated  to  do  his  best  work, 
but  he  has  to  keep  far  afield  and  to  know  what  is 
stirring  in  every  part  of  his  own  domain.  ^^ 

With  a  system  of  fellowships  and  research  scholar- 
ships a  University  may  have  a  body  of  able  young 
men,  who  on  the  outposts  of  knowledge  are  ex- 
ploring, surveying,  defining,  and  correcting.  Their 
work  is  the  outward  and  visible  sign  that  a  Univer- 
sity is  thinking.  ^^ 

Perfect  happiness  for  student  and  teacher  will  come  Examina- 

with  the  abolition  of  examinations,  which  are  stum-  "°^^* 

bling-blocks  and  rocks  of  offence  in  the  pathway  of 

the  true  student.  '^  . 

9 

How  can  we  make  the  work  of  the  student  in  the  Teaching 
third  and  fourth  year  as  practical  as  it  is  in  his  *^^^'^- 
first  and  second  ?  I  take  it  for  granted  we  all  feel 
it  should  be.  The  answer  is:  take  him  from  the 
lecture-room,  and  take  him  from  the  amphitheatre — 
put  him  in  the  out-patient  department,  put  him  in 
the  wards.  It  is  not  the  systematic  lecture,  not  the 
amphitheatre  clinic,  nor  even  the  ward-class — all  of 
which  have  their  value — in  which  the  reformation 
is  needed,  but  in  the  whole  relationship  of  the 
senior  student  to  the  hospital.     During  the  first  two 

L 


146  MEDICAL    EDUCATION 

years,  he  is  thoroughly  at  home  in  the  laboratories, 
domiciled,  we  may  say,  with  his  place  in  each  one, 
to  which  he  can  go  and  work  quietly  under  a 
tutor's  direction  and  guidance.  To  parallel  this 
condition  in  the  third  and  fourth  years  certain  re- 
forms are  necessary.  First,  in  the  conception  of 
how  the  art  of  medicine  and  surgery  can  be  taught. 
My  firm  conviction  is  that  we  should  start  the  third- 
year  student  at  once  on  his  road  of  life.  Ask  any 
physician  of  twenty  years'  standing  how  he  has 
become  proficient  in  his  art,  and  he  wiU  reply, 
by  constant  contact  with  disease ;  and  he  will  add 
that  the  medicine  that  he  learned  in  the  schools 
was  totally  different  from  the  medicine  he  learned 
at  the  bedside.  The  graduate  of  a  quarter  of  a 
century  ago  went  out  with  litde  practical  know- 
ledge, which  increased  only  as  his  practice  increased. 
In  what  may  be  called  the  natural  method  of  teach- 
ing the  student  begins  with  the  patient,  using  books 
and  lectures  as  tools,  as  means  to  an  end.  The 
student  starts,  in  fact,  as  a  practitioner,  as  an  ob- 
server of  disordered  machines,  with  the  structure  and 
orderly  functions  of  which  he  is  perfectly  familiar. 
Teach  him  how  to  observe,  give  him  plenty  of  facts 
to  observe,  and  the  lessons  will  come  out  of  the 
facts  themselves.  For  the  junior  student  in  medicine 
and  surgery  it  is  a  safe  rule  to  have  no  teaching 
without  a  patient  for  a  text,  and  the  best  teaching 
is  that  taught  by  the  patient  himself.  The  whole 
art  of  medicine  is  in  observation,  as  the  old  motto 
goes,  but  to  educate  the  eye  to  see,  the  ear  to  hear, 
and  the  finger  to  feel  takes  time,  and  to  make  a 


MEDICAL   EDUCATION  147 

beginning,  to  start  a  man  on  the  right  path,  is  all 
that  we  can  do.  We  expect  too  much  of  the 
student  and  we  try  to  teach  him  too  much.  Give 
him  good  methods  and  a  proper  point  of  view,  and 
all  other  things  will  be  added  as  his  experience 
grows.  ^^  ^ 

The  second,  and  the  most  important  reform, 
is  in  the  hospital  itself.  In  the  interests  of  the 
medical  student,  of  the  profession,  and  of  the 
pubhc  at  large  we  must  ask  from  the  hospital 
authorities  much  greater  facilities  than  at  present 
enjoyed,  at  least  by  the  students  of  a  majority  of 
the  medical  schools  of  this  country  (United  States). 
The  work  of  the  third  and  fourth  year  should  be 
taken  out  of  the  medical  school  entirely  and  trans- 
ferred to  the  hospital,  which,  as  Abernethy  remarks, 
is  the  proper  college  for  the  medical  student,  in  his 
last  years  at  least.  ^'  ^ 

It  is,  I  think,  safe  to  say  that  in  a  hospital  with 
students  in  the  wards  the  patients  are  more  care- 
fully looked  after,  their  diseases  are  more  fully 
studied  and  fewer  mistakes  made.  The  larger 
question  of  the  extended  usefulness  of  the  hospital 
in  promoting  the  diffusion  of  medical  and  surgical 
knowledge,  I  cannot  here  consider.  ^' 

There  is  no  scarcity  of  material ;  on  the  contrary, 

there  is  abundance.      Think  of  the  plethora   of 

patients  in  this  city  (New  York),  the  large  majority 

of  whom  are  never  seen,  not  to  say  touched  by  a 

L  2 


148 


MEDICAL   EDUCATION 


Study  of  the 
medical  art : 


some  of  the 
difficulties. 


medical  student.  Think  of  the  hundreds  of  typhoid 
fever  patients,  the  daily  course  of  whose  disease  is 
never  watched  or  studied  by  our  pupils !  Think 
of  how  few  of  the  hundreds  of  cases  of  pneumonia 
which  will  enter  the  hospital  during  the  next  three 
months,  will  be  seen  daily,  hourly,  in  the  wards  by 
the  fourth -year  men !  And  yet  it  is  for  this  they  are 
in  the  medical  school,  just  as  much  as,  more  indeed 
than  they  are  in  it  to  learn  the  physiology  of  the 
liver  or  the  anatomy  of  the  hip-joint.  '^'' 

The  great  diflSculty  is  in  the  third  part  of  the 
education  of  the  student,  viz.  his  art.  In  the  old 
days  when  a  lad  was  apprenticed  to  a  general 
practitioner,  he  had  good  opportunities  to  pick  up 
the  essentials  of  a  rough  and  ready  art,  and  the 
system  produced  many  self-reliant,  resourceful 
men.  Then  with  the  multiplication  of  the  medical 
schools  and  increasing  rivalry  between  them  came 
the  two  years'  course,  which  for  half  a  century  lay 
like  a  blight  on  the  medical  profession,  retarding 
its  progress,  filling  its  ranks  with  half-educated  men, 
and  pandering  directly  to  all  sorts  of  quackery, 
humbuggery,  and  fraud.  The  awakening  came 
about  thirty  years  ago,  and  now  there  are  few 
schools  in  this  country  without  a  four  years'  course, 
and  all  are  trying  to  get  clear  of  the  old  shackles 
and  teach  rational  medicine  in  a  rational  way.  But 
there  are  extraordinary  difficulties  in  teaching  the 
medical  student  his  art.  It  is  not  hard,  for  ex- 
ample, to  teach  him  all  about  the  disease  pneumonia, 
how  it  prevails  in  the  winter  and   spring,  how 


MEDICAL   EDUCATION  149 

fetal  it  always  has  been,  all  about  the  germ,  all 
about  the  change  which  the  disease  causes  in  the 
lungs  and  in  the  heart — he  may  become  learned, 
deeply  learned,  on  the  subject — but  put  him  beside 
a  case,  and  he  may  not  know  which  lung  is  in- 
volved, as  he  does  not  know  how  to  find  out,  and 
if  he  did  find  out,  he  might  be  in  doubt  whether 
to  put  an  ice-bag  or  a  poultice  on  the  affected 
side,  whether  to  bleed  or  to  give  opium,  whether 
to  give  a  dose  of  medicine  every  hour  or  none  at 
all,  and  he  may  not  have  the  faintest  notion  whether 
the  signs  look  ominous  or  favourable.  So  also 
with  other  aspects  of  the  art  of  the  general  prac- 
titioner. A  student  may  know  all  about  the  bones  In  practice 
of  the  wrist— in  fact  he  may  carry  a  set  in  his  ^^^^*^*^ 
pocket  and  know  every  facet  and  knob  and  nodule  alone  is 
on  them  ;  he  may  have  dissected  a  score  of  arms ;  inadequate, 
and  yet  when  he  is  called  to  see  Mrs.  Jones,  who 
has  fallen  on  the  ice  and  broken  her  wrist,  he  may 
not  know  a  CoUes'  from  a  Pott's  fracture,  and  as 
for  setting  it  secundum,  artem^  he  may  not  have 
the  faintest  notion,  never  having  seen  a  case.  Or 
he  may  be  called  to  preside  at  one  of  those  awful 
domestic  tragedies — the  sudden  emergency,  some 
terrible  accident  of  birth  or  of  childhood — that 
require  skill,  technical  skill,  courage — the  courage 
of  full  knowledge ;  and  if  he  has  not  been  in  the 
obstetrical  wards,  if  he  has  not  been  trained  prac- 
tically, if  he  has  not  had  the  opportunities  that  are 
the  rights  of  every  medical  student,  he  may  fail  at 
the  critical  moment ;  a  life,  two  lives,  may  be  lost, 
sacrificed  to  ignorance,  often  to  helpless,  involun- 


150 


MEDICAL   EDUCATION 


Instruction 
in  the  art 
the  greatest 
work  of  the 
Johns 
Hopkins 
Hospital. 


Nickel-in- 
the-slot 
attitude  of 
mind. 


tary  ignorance.  By  far  the  greatest  work  of  the 
Johns  Hopkins  Hospital  has  been  the  demonstra- 
tion to  the  profession  of  the  United  States  and  to 
the  public  of  this  country  of  how  medical  students 
should  be  instructed  in  their  art.  I  place  it  first 
because  it  was  the  most  needed  lesson,  I  place  it 
first  because  it  has  done  the  most  good  as  a  stimu- 
lating example,  and  I  place  it  first  because  never 
before  in  the  history  of  this  country  have  medical 
students  lived  and  worked  in  a  hospital  as  part  of 
its  machinery,  as  an  essential  part  of  the  work  of 
the  wards.  In  saying  this  Heaven  forbid  that  I 
should  obliquely  disparage  the  good  and  faithful 
work  of  my  colleagues  elsewhere.  But  the  amphi- 
theatre clinic,  the  ward  and  dispensary  classes,  are 
but  bastard  substitutes  for  a  system  which  makes 
the  medical  student  himself  help  in  the  work  of 
the  hospital  as  part  of  its  human  machinery.  He 
does  not  see  the  pneumonia  case  in  the  amphi- 
theatre from  the  benches,  but  he  follows  it  day 
by  day,  hour  by  hour ;  he  has  his  time  arranged 
that  he  can  follow  it ;  he  sees  and  studies  similar 
cases,  and  the  disease  itself  becomes  his  chief 
teacher,  and  he  knows  its  phases  and  variations  as 
depicted  in  the  living;  he  learns  under  skilled 
direction  when  to  act  and  when  to  refrain ;  he 
learns  insensibly  principles  of  practice,  and  he 
possibly  escapes  a  nickel-in-the-slot  attitude  of 
mind,  which  has  been  the  curse  of  the  physician 
in  the  treatment  of  disease.  And  the  same  with 
the  other  branches  of  his  art ;  he  gets  a  first-hand 
knowledge,  which,  if  he  has  any  sense,  may  make 


MEDICAL    EDUCATION  151 

him  wise  unto  the  salvation  of  his  fellows.  And 
all  this  has  come  about  through  the  wise  provision 
that  the  hospital  was  to  be  part  of  the  medical 
school,  and  it  has  become  for  the  senior  students, 
as  it  should  be,  their  college.  Moreover,  they  are 
not  in  it  upon  sufferance  and  admitted  through 
side-doors,  but  they  are  welcomed  as  important 
aids,  without  which  the  work  could  not  be  done 
efficiently.  The  whole  question  of  the  practical  Practical 
education  of  the  medical  student  is  one  in  which  education, 
the  pubhc  is  vitally  interested.  Sane,  intelligent 
physicians  and  surgeons  with  culture,  science,  and 
art,  are  worth  much  in  a  community,  and  they  are 
worth  paying  for  in  rich  endowments  of  our  medical 
schools  and  hospitals.  Personally  there  is  nothing 
in  my  life  in  which  I  take  greater  pride  than  in 
my  connexion  with  the  organization  of  the  medical 
clinic  of  the  Johns  Hopkins  Hospital,  and  with  the 
introduction  of  the  old-fashioned  methods  of  prac- 
tical instruction.  I  desire  no  other  epitaph  than 
the  statement  that  I  taught  medical  students  in  the  The  ward  as 
wards,  as  I  regard  this  as  by  far  the  most  useful  and  aclass-room. 
important  work  I  have  been  called  upon  to  do.  ** 


There  are  hundreds  of  earnest  students,  thousands 
of  patients,  and  scores  of  well-equipped  young  men 
willing  and  anxious  to  do  practical  teaching.  Too 
often,  as  you  know  full  well,  'the  hungry  sheep 
look  up  and  are  not  fed ' ;  for  the  bread  of  the 
wards  they  are  given  the  stones  of  the  lecture-room 
and  the  amphitheatre.     The  dissociation  of  student 


152 


MEDICAL    EDUCATION 


Students  in 
hospital  (see 
'  Teaching 
the  Art' 
also). 


Experience. 


and  patient  is  a  legacy  of  the  pernicious  system  of 
theoretical  teaching  from  which  we  have  escaped 
in  the  first  and  second  years.  ^^ 

For  the  third-  and  fourth-year  students,  the  hospital 
is  the  college;  for  the  juniors,  the  out-patient 
department  and  the  clinics ;  for  the  seniors,  the 
wards.  They  should  be  in  the  hospital  as  part  of 
its  equipment,  as  an  essential  part,  without  which 
the  work  cannot  be  of  the  best.  They  should  be 
in  it  as  the  place  in  which  alone  they  can  learn  the 
elements  of  their  art  and  the  lesson  which  will  be 
of  service  to  them  when  in  practice  for  themselves.  ^^ 

Each  case  has  its  lesson — a  lesson  that  may  be, 
but  is  not  always,  learnt,  for  clinical  wisdom  is  not 
the  equivalent  of  experience.  A  man  who  may 
have  seen  500  cases  of  pneumonia  may  not  have 
the  understanding  of  the  disease  which  comes  with 
an  intelligent  study  of  a  score  of  cases,  so  different 
are  knowledge  and  wisdom,  which,  as  the  poet 
truly  says,  '  far  from  being  one,  have  oft-times  no 
connexion.'  ^^  , 


Judgement 
difficult. 


Listen  to  the  appropriate  remark  of  the  father  of 
medicine,  who  twenty-five  centuries  ago  had  not 
only  grasped  the  fundamental  conception  of  our  art 
as  one  based  on  observation,  but  had  laboured  also 
through  a  long  life  to  give  to  the  profession  which 
he  loved  the  saving  health  of  science — listen,  I  say, 
to  the  words  of  his  famous  aphorism :  '  Experience 
is  fallacious  and  judgement  difficult ! '  '^ 


MEDICAL    EDUCATION  153 

The  problems  of  disease  are  more  complicated  and  Uncertain- 


ties of 
medicine. 


difficult  than  any  others  with  which  the  trained 
mind  has  to  grapple  ;  the  conditions  in  any  given 
case  may  be  unlike  those  in  any  other  ;  each  case, 
indeed,  may  have  its  own  problem.  Law,  con- 
stantly looking  back,  has  its  forms  and  procedures, 
its  precedents  and  practices.  Once  grasped,  the 
certainties  of  divinity  make  its  study  a  delight  and 
a  pastime ;  but  who  can  tell  of  the  uncertainties  of 
medicine  as  an  art?  The  science  on  which  it  is 
based  is  accurate  and  definite  enough ;  the  physics 
of  a  man's  circulation  are  the  physics  of  the  water- 
works of  the  town  in  which  he  lives,  but  once  out 
of  gear,  you  cannot  apply  the  same  rules  for  the 
repair  of  the  one  as  of  the  other.  '^ 

Variability  is  the  law  of  life.  As  no  two  faces  are  Probability. 
the  same,  so  no  two  bodies  are  alike,  and  no  two 
individuals  react  alike  and  behave  alike  under  the 
abnormal  conditions  which  we  know  as  disease. 
This  is  the  fundamental  difficulty  in  the  education 
of  the  physician,  and  one  which  he  may  never  grasp, 
or  he  takes  it  so  tenderly  that  it  hurts,  instead  of 
boldly  accepting  the  axiom  of  Bishop  Butler,  more 
true  of  medicine  than  of  any  other  profession: 
'  Probability  is  the  guide  of  life.'  Surrounded  by 
people  who  demand  certainty,  and  not  philosopher 
enough  to  agree  with  Locke,  that  '  probability 
supplies  the  defect  of  our  knowledge  and  guides 
us  when  that  fails,  and  is  always  conversant  about 
things  of  which  we  have  no  knowledge,'  the  prac- 
titioner too  often  gets  into  a  habit  of  mind  which 


154 


MEDICAL    EDUCATION 


resents  the  thought  that  opinion,  not  full  knowledge, 
must  be  his  stay  and  prop.  There  is  no  discredit, 
though  there  is  at  times  much  discomfort,  in  this 
everlasting  ^(^^^iz/^"  with  which  we  have  to  preface 
so  much  connected  with  the  practice  of  our  art. 
It  is,  as  I  said,  inherent  in  the  subject.  '^ 

(^ 

Value  of         May  not  the  loss  of  a  professor  bring  stimulating 

chaiigesma  benefits  to  a  University  ?  ...  It  is  strange  of  how 

University       ,     ,  ,        •      i  • 

teaching         slight  value  is  the  unit  in  a  great  system.     A  man 

staff.  may  have  built  up  a  department  and  have  gained 

a  certain  following,  local  or  general;   nay,  more, 

he  may  have  had  a  special  value  for  his  mental  and 

moral  qualities ;  and  his  fission  may  leave  a  scar, 

even  an  aching  scar,  but  it  is  not  for  long.     Those 

of  us  accustomed  to  the  process  know  that  the 

organism  as  a  whole  feels  it  about  as  much  as  a  big 

polyzoon  when  a  colony  breaks  off,  or  a  hive  of  bees 

after  a  swarm— 'tis  not  indeed  always  a  calamity, 

oftentimes  it  is  a  relief.  '^ 

Change  is  the  very  marrow  of  his  existence — 
a  new  set  of  students  every  year,  a  new  set  of 
assistants,  a  new  set  of  associations  every  few  years 
to  replace  those  called  off  to  other  fields  ; — in  any 
active  department  there  is  no  constancy,  no  stability 
in  the  human  surroundings.  And  in  this  there  is 
an  element  of  sadness.  A  man  comes  into  one's 
life  for  a  few  years,  and  you  become  attached  to 
him,  interested  in  his  work  and  in  his  welfare,  and 
perhaps  you  grow  to  love  him  as  a  son,  and  then, 
off  he  goes ! — it  must  be  as  bad  as  having  a  daughter 


The 
professor. 


MEDICAL   EDUCATION  155 

married — leaving  you  with  a  bruised  heart.  After 
teaching  for  thirty  years,  and  coming  into  very 
intimate  contact  with  my  assistants,  my  heart  is  all 
cicatrices,  covered  with  one  big  '  milky  patch.'  ^ 

The  question  may  be  asked  whether,  as  professors.  In-breeding 

we  do  not  stay  too  lonpf  in  one  place.     It  passes  1°  ^®    .^ 

„  University, 

my  persimmon  to  tell  how  some  good  men — even 

lovable  and  righteous  men  in  other  respects — 
have  the  hardihood  to  stay  in  the  same  position 
for  twenty-five  years.  To  a  man  of  active  mind  too 
long  attachment  to  one  college  is  apt  to  breed  self- 
satisfaction,  to  narrow  his  outlook,  to  foster  a  local 
spirit,  and  to  promote  senility.  ** 

A  common  type  of  collegiate  chauvinism  is  mani-  Collegiate 

fest  in  the   narrow  spirit  too  often   displayed  in  cha^yuiism 

.  ,      and  dangers 

filhng   appointments.      The    professoriate   of  the  ©fin-breed- 

profession,  the  most  mobile  column  of  its  great  tog. 
army,  should  be  recruited  with  the  most  zealous 
regard  to  fitness,  irrespective  of  local  conditions 
that  are  apt  to  influence  the  selection.  In-breeding 
is  as  hurtful  to  colleges  as  to  cattle.  The  inter- 
change of  men,  particularly  of  young  men,  is  most 
stimulating,  and  the  complete  emancipation  of 
the  chairs  which  has  taken  place  in  most  of  our 
Universities  should  extend  to  the  medical  schools. 
Nothing,  perhaps,  has  done  more  to  place  German 
medicine  in  the  forefront  to-day  than  a  peripatetic 
professoriate,  owing  allegiance  only  to  the  pro- 
fession at  large,  regardless  of  civic,  sometimes, 
indeed,    of   national    limitations   and   restrictions. 


156  MEDICAL   EDUCATION 

We  acknowledge  the  principle  in  the  case  of  the 
scientific  chairs,  and  with  increasing  frequency  act 
upon  it,  but  an  attempt  to  expand  it  to  other 
chairs  may  be  the  signal  for  the  display  of  rank 
parochialism.  ^^ 

The  There  remains  now  to  foster  that  indefinite  some- 

University  ^.j^ijig  which,  for  want  of  a  better  term,  we  call  the 
University  spirit,  a  something  which  a  rich  institu- 
tion may  not  have,  and  with  which  a  poor  one  may 
be  saturated ;  a  something  which  is  associated  with 
men  and  not  with  money,  which  cannot  be  pur- 
chased in  the  market  or  grown  to  order,  but  which 
comes  insensibly  with  loyal  devotion  to  duty  and 
to  high  ideals,  and  without  which  Nehushian  is 
written  on  the  portals  of  any  school  of  medicine, 
however  famous.  =^^ 


BOOKS,  LIBRARIES,  AND  MEDICAL 
SOCIETIES 


'RELIGIO  MEDICI' 

To  the  writings  of  one  old  physician  I  can  urge  your 
closest  attention.  There  have  been,  and,  happily,  there 
are  still  in  our  ranks  notable  illustrations  of  the  intimate 
relations  between  medicine  and  literature,  but  in  the  group 
of  literary  physicians  Sir  Thomas  Browne  stands  pre- 
eminent. The  Religio  Medici,  one  of  the  great  English 
classics,  should  be  in  the  hands— in  the  heart  too — of 
every  medical  student.  As  I  am  on  the  confessional 
to-day,  I  may  tell  you  that  no  book  has  had  so  endiuing 
an  influence  on  my  life.  I  was  introduced  to  it  by  my 
first  teacher,  Rev.  W.  A.  Johnson,  Warden  and  Founder 
of  Trinity  College  School,  and  I  can  recall  the  delight 
with  which  I  first  read  its  quaint  and  charming  pages.  It 
was  one  of  the  strong  influences  which  turned  my  thoughts 
towards  medicine  as  a  profession,  and  my  most  treasured 
copy— the  second  book  I  ever  bought — has  been  a  constant 
companion  for  thirty-one  years,  comes  viae  vitaeque.  '^ 


158 


BOOKS,    LIBRARIES;    AND 


library. 


The  value  of  The  organization  of  a  library  means  effort,  it  means 
e  ocai  union,  it  means  progress.  It  does  good  to  men 
who  start  it,  who  help  with  money,  with  time  and 
with  the  gifts  of  books.  It  does  good  to  the  young 
men,  with  whom  our  hopes  rest,  and  a  library 
gradually  and  insensibly  moulds  the  profession  of 
a  town  to  a  better  and  higher  status. ' 


The  Index 
Catalogue. 


I  need  not  refer  in  this  audience  to  the  use  of  the 
Index  Catalogue  in  library  work  ;  it  is  also  of  in- 
calculable value  to  any  one  interested  in  books. 
Let  me  give  an  everyday  illustration.  From  the 
library  of  my  friend,  the  late  Dr.  Rush  Huidekoper, 
was  sent  to  me  a  set  of  very  choice  old  tomes,  among 
which  was  a  handsome  folio  of  the  works  of  du 
Laurens,  a  sixteenth  -  century  physician.  I  had 
never  heard  of  him,  but  was  very  much  interested 
in  some  of  his  medical  dissertations.  In  a  few 
moments  from  the  Index  Catalogue  the  whole 
bibliography  of  the  man  was  before  me,  the  dates 
of  his  birth  and  death,  the  source  of  his  biblio- 
graphy, and  where  to  look  for  his  portrait.  It  is 
impossible  to  over-estimate  the  boon  which  this 
work  is  to  book-lovers.  ^ 


The  reaper 
often  not 
the  sower. 


Too  often  the  reaper  is  not  the  sower.  Too  often 
the  fate  of  those  who  labour  at  some  object  for  the 
public  good  is  to  see  their  work  pass  into  other 
hands,  and  to  have  others  get  the  credit  for  en- 
terprises which  they  have  initiated  and  made 
possible.  '^ 


MEDICAL    SOCIETIES  159 

It  is  hard  for  me  to  speak  of  the  value  of  libraries  Books, 
in  terms  which  would  not  seem  exaggerated.  Books  ^^^^  o^ 
have  been  my  delight  these  thirty  years,  and  from 
them  I  have  received  incalculable  benefits.  '^ 

To  study  the  phenomena  of  disease  without  books 
is  to  sail  an  uncharted  sea,  while  to  study  books 
without  patients  is  not  to  go  to  sea  at  all.  ^' 

Only  a  maker  of  books  can  appreciate  the  labours 
of  others  at  their  true  value.  Those  of  us  who  have 
brought  forth  fat  volumes  should  offer  hecatombs 
at  the  shrines  of  Minerva  Medica.  What  exsuccous, 
attenuated  offspring  they  would  have  been  but  for 
the  pabulum  furnished  through  the  placental  circu- 
lation of  a  library !  How  often  can  it  be  said  of  us 
with  truth,  Das  beste  was  er  ist  verdankt  er 
Andernl^^  . 

But  when  one  considers  the  unending  making  of  Sir  William 
books,  who  does  not  sigh  for  the  happy  days  of  ?^^!^®  ^ 
that  thrice  happy  Sir  William  Browne,  whose  pocket  library, 
library  sufficed  for  his  life's  needs  ;  drawing  from 
a  Greek  testament  his  divinity,  from  the  aphorisms 
of  Hippocrates  his  medicine,  and  from  an  Elzevir 
Horace  his  good  sense  and  vivacity  ?  ^' 

There  should  be  in  connexion  with  every  library  Library 
a  corps  of  instructors  in  the  art  of  reading,  who  uistructors. 
would,  as  a  labour  of  love,  teach  the  young  how  to 
read.  ^' 


l6o  BOOKS;    LIBRARIES,    AND 

Books.  It  was  a  singularly  judicious  action  on  the  part  of 

the  men  who  controlled  this  institution  (in  the 
thirties)  to  begin  a  collection  of  books.  They 
knew  the  true  gauge  of  a  profession's  standing,  not 
the  number  of  its  schools,  not  the  length  of  the  roll 
of  students,  not  the  material  wealth  of  the  physicians; 
these  are  as  dross  and  slag,  chaff  and  dust,  in 
estimating  the  true  worth  of  a  profession.  Books 
are  tools,  doctors  are  craftsmen,  and  so  truly  as  one 
can  measure  the  development  of  any  particular 
handicraft  by  the  variety  and  complexity  of  its 
tools,  so  we  have  no  better  means  of  judging  the 
intelligence  of  a  profession  than  by  its  general 
collection  of  books.  A  physician  who  does  not  use 
books  and  journals,  who  does  not  need  a  library, 
who  does  not  read  one  or  two  of  the  best  weeklies 
and  monthlies,  soon  sinks  to  the  level  of  the  cross- 
counter  prescriber,  and  not  alone  in  practice,  but  in 
those  mercenary  feelings  and  habits  which  charac- 
terize a  trade. '°  . 

The  true  worker  does  not  want  textbooks ;  he 
looks  to  journal  literature  and  monographs,  and  the 
extraordinary  development  of  all  special  depart- 
ments makes  the  work  of  a  library  committee 
very  difficult  unless  it  has  a  rich  appropriation. '° 

Four  sorts  An  old  writer  says  that  there  are  four  sorts  of 
readers :  '  Sponges,  which  attract  all  without  dis- 
tinguishing ;  Howre-glasses,  which  receive  and  powre 
out  as  fast ;  Bagges,  which  only  retain  the  dregges 
of  the  spices  and  let  the  wine  escape ;  and  Sieves, 


of  readers. 


MEDICAL    SOCIETIES  l6l 

which  retaine  the  best  onely.'   A  man  wastes  a  great 
many  years  before  he  reaches  the  '  sieve  '  stage.  ^^ 

No  class  of  men  needs  friction  so  much  as  physicians ;  The  Medical 
no  class  gets  less.  The  daily  round  of  a  busy  ^oaety. 
practitioner  tends  to  develop  an  egoism  of  a  most 
intense  kind,  to  which  there  is  no  antidote.  The 
few  set-backs  are  forgotten,  the  mistakes  are  often 
buried,  and  ten  years  of  successful  work  tend  to 
make  a  man  touchy,  dogmatic,  intolerant  of  correc- 
tion, and  abominably  self-centred.  To  this  mental 
attitude  the  Medical  Society  is  the  best  corrective, 
and  a  man  misses  a  good  part  of  his  education  who 
does  not  get  knocked  about  a  bit  by  his  colleagues 
in  discussions  and  criticisms. '° 

The  very  marrow  and  fitness  of  books  may  not  Books  alone 
suffice  to  save  a  man  from  becoming  a  poor,  mean-  °°  enoug 
spirited  devil,  without  a  spark  of  fine  professional 
feeling,  and  without  a  thought  above  the  sordid 
issues  of  the  day. '°         . 

The  promotion  and  dissemination  of  medical  know-  The 

ledg-e  throupfhout  the  State  remains  our  important  ^^^S^f^ 
*=>*»_  ^        ^       against 

function.     Physicians  as  a  rule  have  less  apprecia-  banefiil  in- 
tion  of  the  value  of  organization  than  the  members  dividualism 
of  other    professions.     In    large   cities    weakness  Medical 
results  from  the  breaking  into  cliques  and  coteries,  Society, 
the  interests  of  which  take  precedence  over  others 
of  wider  and  more  public  character.   Jealousies  and 
misunderstandings  are  not  unknown,  and  there  is 
a  baneful  individualism — every  man  for  himself — 

M 


satisfied 
man. 


162  BOOKS,    LIBRARIES,    ETC. 

a  centrifugalizing  influence  againstwhich  the  Society 
is  and  has  been  the  only  enduring  protest. '° 

The  self-  The  man  who  knows  it  all  and  gets  nothing  from 
the  Society  reminds  one  of  that  little  dried -up 
miniature  of  humanity,  the  prematurely  senile  infant, 
whose  tabetic  marasmus  has  added  old  age  to  in- 
fancy. Why  should  he  go  to  the  Society  and  hear 
Dr.  Jones  on  the  gastric  relations  of  neurasthenia 
when  he  can  get  it  so  much  better  out  of  the  works 
of  Einhorn  or  Ewald  ?  He  is  weary  of  seeing 
appendices,  and  there  are  no  new  pelvic  viscera  for 
demonstration.  It  is  a  waste  of  time,  he  says,  and 
he  feels  better  at  home,  and  perhaps  that  is  the  best 
place  for  a  man  who  has  reached  this  stage  of 
intellectual  stagnation.  '^ 


VALUE  OF  TRAVEL 


TRAVEL 

To  walk  the  wards  at  Guy's  or  St,  Bartholomew's,  to 
see  the  work  at  the  St.  Louis  or  the  SalpetriSre,  to  put  in 
a  few  quiet  months  of  study  at  one  of  the  German 
university  towns,  will  store  the  young  man's  mind  with 
priceless  treasures.  I  assxune  that  he  has  a  mind.  I  am 
not  heedless  of  Shakespeare's  sharp  taunt  :— 

•How  much  the  fool  that  hath  been  sent  to  Rome 
Exceeds  the  fool  that  hath  been  kept  at  home ! ' 


M  Z 


164 


VALUE    OF 


Travel.  If  he  (the  physician)  cannot  go  abroad,  let  him 

spend  part  of  his  short  vacations  in  seeing  how 
it  fares  with  the  brethren  in  his  own  country. 
Even  a  New  Yorker  will  learn  something  in  the 
Massachusetts  General  and  the  Boston  City  Hos- 
pitals. A  trip  to  Philadelphia  would  be  most 
helpful;  there  is  much  to  stimulate  the  mind  at 
the  old  Pennsylvania  Hospital  and  at  the  Univer- 
sity, and  he  would  be  none  the  worse  for  a  few 
weeks  spent  still  further  south  on  the  banks  of  the 
Chesapeake.  The  all-important  matter  is  to  get 
breadth  of  view  as  early  as  possible,  and  this  is 
difficult  without  travel.^ 

Meanwhile,  to  students  who  wish  to  have  the  best 
that  the  world  offers,  let  me  suggest  that  the  lines 
of  intellectual  progress  are  veering  strongly  to  the 
West,  and  I  predict  that  in  the  twentieth  century 
the  young  English  physicians  will  find  their  keenest 
inspiration  in  the  land  of  the  setting  sun. ' 

Catholicity.  If  the  work  is  to  be  effective,  the  student  must  keep 
jn  touch  with  scholars  in  other  countries.  How  often 
has  it  happened  that  years  of  precious  time  have 
been  given  to  a  problem  already  solved  or  shown  to 
be  insoluble,  because  of  the  ignorance  of  what  had 
been  done  elsewhere !  And  it  is  not  only  book 
knowledge  and  journal  knowledge,  but  a  knowledge 
of  men  that  is  needed.  The  student  will,  if  possible, 
see  the  men  in  other  lands.  Travel  not  only 
widens  the  vision  and  gives  certainties  in  place 
of  vague  surmises,  but  the  personal  contact  with 


The  future 
with  the 
West. 


TRAVEL  165 

foreign  workers  enables  him  to  appreciate  better 

the  faiUngs  or  successes  in  his  own  line  of  work, 

perhaps  to  look  with  more    charitable   eyes  on 

the  work  of  some  brother  whose  limitations  and 

opportunities  have  been  more  restricted  than  his 

own.  '^^  X 

9 

There    are   two  appalling  diseases  which  only  a  Infantilism 

fehne   restlessness  of  mind  and  body  may  '  head  P  ^ 

teacber. 
off  *  in  young  men  in  the  academic  career.     There 

is  a  remarkable  bodily  condition,  known  as  in- 

fantihsm,   in    which    adolescence  does    not   come 

at  the  appointed   time,  or   is  deferred  until  the 

twentieth  year  or  later,  and  is  then   incomplete, 

so  that  the  childish  mind  and  the  childish  form  and 

features  remain.     The  mental  counterpart  is  even 

more  common  among  us.     Intellectual  infantilism 

is  a  well-recognized  disease,  and  just  as  imperfect 

nutrition    may    cause    failure    of    the    marvellous 

changes  which  accompany  puberty  in  the   body, 

so  the  mind  too  long  fed  on  the  same  diet  in  one 

place  may  be  rendered  rickety  or  even  infantile. 

Worse  than  this   may  happen.     A  rare,  but   still  Progeria  in 

more  extraordinary,  bodily  state  is  that  of  progeria,         teacher. 

in  which,  as  though  touched  with  the  wand  of  some 

mahgn  fairy,  the  child  does  not  remain  infantile, 

but  skips  adolescence,  maturity,  and  manhood,  and 

passes  at  once  to  senility,  looking  at  eleven   or 

twelve  years  like  a  miniature   Tithonus  'marred 

and  wasted,'  wrinkled  and  stunted,  a  little  old  man 

among  his  toys.     It  takes  great  care  on  the  part 

of  any  one  to  live  a  mental  life  corresponding  to 


l66  VALUE   OF 

the  ages  or  phases  through  which  his  body  passes. 
How  few  minds  reach  puberty,  how  few  come  to 
adolescence,  how  few  attain  maturity !  It  is  really 
tragic — this  widespread  prevalence  of  mental  in- 
fantilism, due  to  careless  habits  of  intellectual  feed- 
ing. Progeria  is  an  awful  malady  in  a  college. 
Few  faculties  escape  without  an  instance  or  two, 
and  there  are  certain  diets  which  cause  it  just  as 
surely  as  there  are  waters  in  some  of  the  Swiss 
valleys  that  produce  cretinism.  I  have  known  -an 
entire  faculty  attacked.  The  progeric  himself  is 
a  nice  enough  fellow  to  look  at  and  to  play  with, 
but  he  is  sterile,  with  the  mental  horizon  narrowed, 
and  quite  incapable  of  assimilating  the  new  thoughts 
of  his  day  and  generation. 

As  in  the  case  of  many  other  diseases,  it  is  more 
readily  prevented  than  cured,  and,  taken  early, 
change  of  air  and  diet  may  do  much  to  antagonize 
a  tendency,  inherited  or  acquired.  Early  stages 
may  be  relieved  by  a  prolonged  stay  at  the 
University  Baths  of  Berlin  or  Leipzig,  or  if  at 
the  proper  time  a  young  man  is  transferred  from 
an  American  or  Anglican  to  a  Gallic  or  Teutonic 
diet.  Through  no  fault  of  the  men,  but  of  the 
system,  due  to  the  unfortunate  idea  on  the  part 
of  the  denominations  that  in  each  one  of  the  States 
they  should  have  their  own  educational  institutions, 
collegiate  infantilism  is  far  too  prevalent,  against 
which  the  freer  air  and  better  diet  of  the  fully 
equipped  State  Universities  are  proving  a  rapid,  as 
they  are  the  rational,  antidote.  ** 


TRAVEL  167 

I  wish  we  could  encourage  on  this  continent  The  narrow 
(America)  among  our  best  students  the  habit  of  ^P*^^*- 
wandering.  I  do  not  know  that  we  are  quite  pre- 
pared for  it,  as  there  is  still  great  diversity  in  the 
curricula,  even  among  the  leading  schools,  but  it 
is  undoubtedly  a  great  advantage  to  study  under 
different  teachers,  as  the  mental  horizon  is  widened 
and  the  sympathies  enlarged.  The  practice  would 
do  much  to  lessen  that  narrow  '  I  am  of  Paul  and 
I  am  of  Apollos '  spirit  which  is  hostile  to  the  best 
interests  of  the  profession,  '*^ 

It  is  more  particularly  upon  the  younger  men  that  Advantages 
I  would  urge  the  advantages  of  an  early  devotion  °    •  ^  t  H 
to  a  peripatetic  philosophy  of  life.     Just  so  soon  Ufe  for  the 
as  you  have  your  second  teeth  think  of  a  change ;  teacher, 
get  away  from  the  nurse,  cut  the  apron-strings  of 
your  old  teachers,  seek  new  ties  in  a  fresh  environ- 
ment, if  possible,  where  you  can  have  a  certain 
measure  of  freedom  and  independence.     Only  do 
not  wait  for  a  fully -equipped  billet  almost  as  good 
as  that  of  your  master.     A  small  one,  poorly  ap- 
pointed, with  many  students  and  few  opportunities 
for  research,  may  be  just  what  is  needed  to  bring 
out  the  genius — latent  and  perhaps  unrecognized — 
that  will  enable  you  in  an  unfavourable  position  to 
do  well  what  another  could  not  do  at  all,  even  in 
the  most  helpful  surroundings.  *^ 

Nor  would  I  limit  this  desire  for  change  to  the 
teachers.     The  student    of  the   technical   school 


l68  VALUE    OF 

should  begin  his  Wanderj'ahre  early,  not  post- 
poning them  until  he  has  taken  his  M.D.  or  Ph.D. 
A  residence  of  four  years  in  the  one  school  is  apt 
to  breed  prejudice  and  to  promote  mental  astigma- 
tism which  the  after  years  may  never  be  able  to 
correct.  "^  ^ 

V 

Travel  and     Permanence  of  residence,  good  undoubtedly  for  the 
c  ange.  pocket,  is  not  always  best  for  wide  mental  vision 

in  the  physician.  , 

You  (army  surgeons)  are  modern  representatives 
of  a  professional  age  long  past,  of  a  day  when 
physicians  of  distinction  had  no  settled  homes. 
You  are  Cyprid  larvae,  unattached,  free-swimming, 
seeing  much  in  many  places ;  not  fixed  as  we 
barnacles  of  civil  life,  head  downward,  degenerate 
descendants  of  the  old  professional  Cirripeds,  who 
laid  under  contribution  not  one  but  a  score  of 
cities.  ^^  , 

Morgan,  Rush,  Shippen,  Bard,  Wistar,  Hossack, 
and  others  had  received  an  education  comprising 
all  that  was  best  in  the  period,  and  had  added  the 
acquired  culture  which  can  come  only  from  travel 
and  wide  acquaintance  with  the  world,  "t 

Morgan,  the  founder  of  the  medical  school  of 
the  University  of  Pennsylvania,  was  away  seven 
years,  and  before  returning  had  taken  his  seat  as 
a  corresponding  member  of  the  French  Academy 
of  Surgery,  besides  having  been  elected  a  Fellow 
of  the  Royal  Society.  * 


TRAVEL  169 

In  a  nomad  life  this  common  infirmity,  to  the 
entertainment  of  which  the  twin  sisters,  Use  and 
Wont,  lend  their  ever  ready  aid,  will  scarcely 
touch  you  (the  army  surgeon),  and  for  this  mercy 
give  thanks ;  and  while  you  must,  as  men,  entertain 
many  idols  of  the  tribe,  you  may  at  least  escape  the 
idol  of  the  cave.  Enjoying  the  privilege  of  wide 
acquaintance  with  men  of  varied  capabilities  and 
training,  you  can,  as  spectators  of  their  many 
crotchets  and  of  their  little  weaknesses,  avoid  placing 
an  undue  estimate  on  your  own  individual  powers 
and  position.  ^^ 

If  the  licence  to  practise  meant  the  completion  of  Foreign 
his  education,  how  sad  it  would  be  for  the  young  travel, 
practitioner,  how  distressing  to  his  patients !  More 
clearly  than  any  other  the  physician  should  illus- 
trate the  truth  of  Plato's  saying,  that  education  is 
a  lifelong  process.  The  training  of  the  medical 
school  gives  a  man  his  direction,  points  him  the  way, 
and  furnishes  him  with  a  chart,  fairly  incomplete, 
for  the  voyage,  but  nothing  more.  Post-graduate 
study  has  always  been  a  characteristic  feature  of  our 
profession.  These  three  hundred  years  the  schools 
of  Italy,  Holland,  France,  Austria,  and  Germany 
have  in  turn  furnished  instruction  to  the  young 
English  practitioners  who  believed  in  the  catholicity 
of  medicine,  and  who  felt  the  sharp  sting  of  the 
remark  which  associates  homely  wits  with  home- 
keeping  youths.  At  first  it  was  the  grand  tour, 
and  many  of  the  masters  spent  years  in  foreign 
study.     In  spite  of  our  journals  and  international 


170  VALUE    OF    TRAVEL 

societies  and  increased  facilities  for  travel,  I  am 
not  sure  that,  among  the  teachers  in  our  art  the 
world  over,  medicine  to-day  is  more  cosmopolitan 
than  it  was  in  the  seventeenth  and  eighteenth 
centuries.  We  now  spend  a  few  months  or  a  year 
in  foreign  study,  whereas  our  great-grandfathers 
thought  nothing  of  two  and  three  years.  I  have 
seen  the  manuscript  journal  of  Dr.  John  Morgan 
(a  Pennsylvania  colonist),  the  founder  of  the  first 
medical  school  in  America  (University  of  Pennsyl- 
vania), who  after  graduation  at  Edinburgh,  spent 
three  years  on  the  continent,and  became  thoroughly 
familiar  with  Italian,  Dutch,  and  French  medicine, 
reaching  such  distinction  as  a  student  that  he  took 
his  seat  as  a  corresponding  member  of  the  Paris 
Academy  of  Surgery,  and  was  elected  a  Fellow  of 
the  Royal  Society.  ^ 


THE  PRACTITIONER  OF  MEDICINE 

The  Student  Practitioner 
The  General  Practitioner 
The  Specialist 
The  Consultant 


PHYSICIANS— TWO  SORTS 

There  are  only  two  sorts  of  doctors :  those  who  practise 
with  their  brains,  and  those  who  practise  with  their 
tongues.  "^ 


THE  TRUE  PHYSICIAN 

The  studious  hard-working  man  who  wishes  to  know 
his  profession  thoroughly,  who  lives  in  the  hospitals  and 
dispensaries,  and  who  strives  to  obtain  a  wide  and  philo- 
sophical conception  of  disease  and  its  processes,  often  has 
a  hard  struggle,  and  it  may  take  years  of  waiting  before 
he  becomes  successful ;  but  such  form  the  bulwarks  of  our 
ranks,  and  outweigh  scores  of  the  voluble  Cassios  who 
talk  themselves  into,  and  often  out  of,  practice.  "^ 


172  THE    PRACTITIONER 

The  waiting  Medicine  is  a  most  difficult  art  to  acquire.     All  the 
years.  college  can  do  is  to  teach  the  student  principles, 

based  on  facts  in  science,  and  give  him  good  methods 
of  work.  These  simply  start  him  in  the  right 
direction ;  they  do  not  make  him  a  good  practi- 
tioner— that  is  his  own  affair.  To  master  the  art 
requires  sustained  effort,  like  the  bird's  flight  which 
depends  upon  the  incessant  action  of  the  wings,  but 
this  sustained  effort  is  so  hard  that  many  give  up 
the  struggle  in  despair.  And  yet  it  is  only  by  per- 
sistent intelligent  study  of  disease  upon  a  methodical 
plan  of  examination  that  a  man  gradually  learns  to 
correlate  his  daily  lessons  with  the  facts  of  his 
previous  experience  and  of  that  of  his  fellows,  and 
so  acquires  clinical  wisdom.  Nowadays  it  is  really 
not  a  hard  matter  for  a  well-trained  man  to  keep 
abreast  of  the  best  work  of  the  day.  He  need  not 
be  very  scientific  so  long  as  he  has  a  true  apprecia- 
tion of  the  dependence  of  his  art  on  science,  for,  in 
a  way,  it  is  true  that  a  good  doctor  may  have  practice 
and  no  theory,  art  and  no  science.  To  keep  up 
a  familiarity  with  the  use  of  instruments  of  precision 
is  an  all-important  help  in  his  art,  and  I  am  pro- 
foundly convinced  that  as  much  space  should  be 
given  to  the  clinical  laboratory  as  to  the  dispensary. 
One  great  difficulty  is  that  while  waiting  for  the 
years  to  bring  the  inevitable  yoke,  a  young  fellow 
gets  stale  and  loses  that  practised  familiarity  with 
technique  which  gives  confidence.  I  wish  the  older 
practitioners  would  remember  how  important  it  is 
to  encourage  and  utilize  the  young  men  who  settle 
near  them.   In  every  large  practice  there  are  a  dozen 


OF    MEDICINE  173 

or  more  cases  requiring  skilled  aid  in  diagnosis,  and 

this  the  general  practitioner  can  have  at  hand.     It 

is  his  duty  to  avail  himself  of  it,  and  failing  to  do  so 

he  acts  in  a  most  illiberal  and  unjust  way  to  himself 

and  to  the  profession  at  large.     Not  only  may  the 

older  man,  if  he  has  soft  arteries  in  his  grey  cortex, 

pick  up  many  points  from  the  young  fellow,  but 

there  is  much  clinical  wisdom  afloat  in  each  parish 

which  is  now  wasted  or  dies  with  the  old  doctor, 

because  he  and  the  young  men  have  never  been  on 

friendly  terms.  ^^ 

9 

From  the  vantage-ground  of  more  than  forty  years  Three 

of  hard  work,  Sir  Andrew  Clark  told  me  that  he  periods  of 

had  striven  ten  years  for  bread,  ten  years  for  bread  cian's  life. 

and  butter,  and  twenty  years  for  cake  and  ale ;  and 

this  is  really  a  very  good  partition  of  the  life  of  the 

student  of  internal  medicine,  of  some  at  least,  since 

all  do  not  reach  the  last  stage.  ^ 

During  this  period  (first  ten  years  after  graduation)  Time  is 
let  him  (the  young  physician)  not  lose  the  substance  ^^^^Y- 
of  ultimate  success  in  grasping  at  the  shadow  of 
present  opportunity.  Time  is  now  his  money,  and 
he  must  not  barter  away  too  much  of  it  in  profitless 
work — profitless  so  far  as  his  education  is  concerned, 
though  it  may  mean  ready  cash.  ^ 

Five  years,  at  least,  of  trial  await  the  man  after  The  waiting 
parting  from  his  teachers,  and  entering  upon  an  y^*"^ 
independent  course — years  upon  which  his  future 
depends  and  from  which  his  horoscope  may  be  cast 


174  THE    PRACTITIONER 

with  certainty.  It  is  all  the  same  whether  he  settles 
in  a  country  village,  or  goes  on  with  hospital  and 
laboratory  work ;  whether  he  takes  a  prolonged  trip 
abroad ;  or  whether  he  settles  down  in  practice,  with 
a  father  or  a  friend — these  five  waiting  years  fix  his 
fate  so  far  as  the  student  life  is  concerned.  Without 
any  strong  natural  propensity  to  study,  he  may  feel 
such  a  relief  after  graduation  that  the  efibrt  to  take 
to  books  is  beyond  his  mental  strength,  and  a  weekly 
journal  with  an  occasional  textbook  furnish  pabulum 
Dead  enough,  at  least,  to  keep  his  mind  hibernating.     But 

mentally  in  ^^^  years  later  he  is  dead  mentally,  past  any  possible 
without  hope  of  galvanizing  into  life  as  a  student,  fit  to  do 
study.  a  routine  practice,  often  a  capable,  resourceful  man, 

but  without  any  deep  convictions,  and  probably  more 
interested  in  stocks  or  in  horses  than  in  diagnosis 
or  therapeutics.  But  this  is  not  always  the  fate  of 
the  student  who  finishes  his  work  on  Commence- 
ment Day.  There  are  men  full  of  zeal  in  practice, 
who  give  good  service  to  their  fellow  creatures, 
who  have  not  the  capacity  or  the  energy  to  keep  up 
with  the  times.  While  they  have  lost  interest  in 
science,  they  are  loyal  members  of  the  profession, 
and  appreciate  their  responsibihties  as  such.  That 
fateful  first  lustrum  ruins  some  of  our  most  likely 
material.  Nothing  is  more  trying  to  the  soldier 
than  inaction,  to  mark  time  while  the  batde  is 
raging  all  about  him;  and  waiting  for  practice 
is  a  serious  strain  under  which  many  yield.  In  the 
cities  it  is  not  so  hard  to  keep  up :  there  is  work 
in  the  dispensaries  and  colleges,  and  the  stimulus 
of  the  medical  societies ;  but  in  smaller  towns  and 


OF    MEDICINE  175 

in  the  country  It  takes  a  strong  man  to  live  through 
the  years  of  waiting  without  some  deterioration.  '^^ 

It  is  a  common  error  to  think  that  the  more  a  doctor  Simply  see- 
sees  the  greater  his  experience  and  the  more  he  iJ^gJ^otali. 
knows.  No  one  ever  drew  a  more  skilful  distinction 
than  Cowper  in  his  oft-quoted  lines,  which  I  am 
never  tired  of  repeating  in  a  medical  audience : — 

*  Knowledge  and  wisdom,  far  from  being  one. 
Have  oft-times  no  connexion.    Knowledge  dwells 
In  heads  replete  with  thoughts  of  other  men ; 
Wisdom  in  minds  attentive  to  their  own. 
Knowledge  is  proud  that  he  has  learned  so  much ; 
Wisdom  is  humble  that  he  knows  no  more."^^ 

What  we  call  sense  or  wisdom  is  knowledge,  ready  Sense  and 
for  use,  made  effective,  and  bears  the  same  relation  Z^*^°^  ^h' 
to  knowledge  itself  that  bread  does  to  wheat.     The  knowledge, 
full  knowledge  of  the  parts  of  a  steam  engine  and 
the  theory  of  its  action  may  be  possessed  by  a  man 
who  could  not  be  trusted  to  pull  the  lever  to  its 
throtde.     It  is  only  by  collecting  data  and  using 
them  that  you  can  get  sense.     One  of  the  most 
delightful  sayings  of  antiquity  is  the  remark  of 
Heraclitus  about  his  predecessors — that  they  had 
much  knowledge,  but  no  sense.  *^ 

I  wish  I  had  time  to  speak  of  the  value  of  note-  Note-taking. 

taking.    You  can  do  nothing  as  a  student  in  practice 

without  it.      Carry  a  small  notebook  which  will  fit 

into  your  waistcoat  pocket,  and  never  ask  a  new 

patient  a  question  without  notebook  and  pencil  in 

hand.    After  the  examination  of  a  pneumonia  case 


176  THE    PRACTITIONER 

two  minutes  will  suffice  to  record  the  essentials  in 
Routine  and  the  daily  progress.  Routine  and  system,  when  once 
system.  made  a  habit,  facilitate  work,  and  the  busier  you 

are  the  more  time  you  will  have  to  make  observa- 
tions after  examining  a  patient.  Jot  a  comment  at 
the  end  of  the  notes :  '  clear  case,'  '  case  illustrating 
obscurity  of  symptoms,'  'error  in  diagnosis,'  &c. 
The  making  of  observations  may  become  the  exer- 
cise of  a  jackdaw-like  trick,  like  the  craze  which  so 
many  of  us  have  to  collect  articles  of  all  sorts.  The 
study  of  the  cases,  the  relation  they  bear  to  each 
other  and  to  the  cases  in  literature — here  comes  in 
the  difficulty.  Begin  early  to  make  a  threefold 
category  —  clear  cases,  doubtful  cases,  mistakes. 
Play  the  And  learn  to  play  the  game  fair,  no  self-deception, 
^™®  *  no  shrinking  from  the  truth  ;  mercy  and  considera- 
tion for  the  other  man,  but  none  for  yourself,  upon 
whom  you  have  to  keep  an  incessant  watch.  You 
remember  Lincoln's  famous  mot  about  the  impossi- 
bility of  fooling  all  of  the  people  all  of  the  time. 
It  does  not  hold  good  for  the  individual  who  can 
fool  himself  to  his  heart's  content  all  of  the  time.  If 
necessary,  be  cruel ;  use  the  knife  and  the  cautery 
to  cure  the  intumescence  and  moral  necrosis  which 
you  will  feel  in  the  posterior  parietal  region,  in 
Gall  and  Spurzheim's  centre  of  self-esteem,  where 
you  will  find  a  sore  spot  after  you  have  made 
The  only  a  mistake  in  diagnosis.  It  is  only  by  getting  your 
way  to  make  ^^ses  grouped  in  this  way  that  you  can  make  any 
gress.  real   progress    in   your  post-collegiate   education ; 

only  in  this  way  can  you  gain  wisdom  with  ex- 
perience. "^^ 


OF   MEDICINE  177 

Of  the  three  well-stocked  rooms  which  it  should  The  de- 
be  the  ambition  of  every  young-  doctor  to  have  in  his  ^<*^^ta  of 

■'  ■'        ^  every  young 

house,  the  library,  the  laboratory,  and  the  nursery —  doctor. 

books,  balances,  and  bairns — as  he  may  not  achieve 
all  three,  I  would  urge  him  to  start  at  any  rate  with 
the  books  and  the  balances.     A  good  weekly  and 
a  good  monthly  journal  to  begin  with,  and  read 
them.      Then,  for  a  systematic   course  of  study, 
supplement  your  college  textbooks  with  the  larger 
systems — AUbutt  or  Nothnagel — a  system  of  sur- 
gery, and,  as  your  practice  increases,  make  a  habit 
of  buying  a  few  special  monographs  every  year. 
Read  with  two  objects:  first,  to  acquaint  yourself 
with  the  current  knowledge  on  a  subject  and  the 
steps  by  which  it  has  been  reached ;  and  secondly, 
and    more    important,   read    to    understand    and 
analyse  your  cases.      To   this  line  of  work  we 
should  direct  the  attention  of  the  student  before 
he  leaves  the  medical  school,  pointing  in  specific 
cases  just  where  the  best  articles  are  to  be  found, 
sending  him  to  thelndexC  atalogue — that  marvellous  The  Index 
storehouse,  every  page  of  which  Is  interesting  and  Catalogue, 
the  very  titles  instructive.    Early  learn  to  appreciate 
the  differences  between  the  descriptions  of  disease 
and  the  manifestations  of  that  disease  in  an  in- 
dividual— the    difference    between    the    composite  The  work- 
portrait  and  one  of  the  component  pictures.     By  "^S  library, 
exercise  of  a  little  judgement  you  can  collect  at 
moderate  cost  a  good  working  library.    Try,  in  the  History  of 
waiting  years,  to  get  a  clear  idea  of  the  history  of  ™^^*^"^^' 
medicine.     Read  Foster's  Lectures  on  the  History 
of  Physiology^  Baas's  History  of  Medicine.   Get  the 

N 


178 


THE    PRACTITIONER 


Have  an 
avocation. 


Value  of 
autopsies. 


Publication. 


*  Masters  of  Medicine  '  Series,  and  subscribe  to  the 
Library  and  Historical  Journal. 

Every  day  do  some  reading  or  work  apart  from 
your  profession.  I  fully  realize,  no  one  more  so, 
how  absorbing  is  the  profession  of  medicine,  how 
applicable  to  it  is  what  Michelangelo  says,  '  There 
are  sciences  which  demand  the  whole  of  a  man, 
without  leaving  the  least  portion  of  his  spirit  free 
for  other  distractions  ' ;  but  you  will  be  a  better  man 
and  not  a  worse  practitioner  for  an  avocation.  "^^ 

In  this  dry-bread  period  he  should  see  autopsies 
daily,  if  possible.  Successful  knowledge  of  the 
infinite  variations  of  disease  can  only  be  obtained 
by  a  prolonged  study  of  morbid  anatomy.  While 
of  special  value  in  training  the  physician  in  dia- 
gnosis, it  also  enables  him  to  correct  his  mistakes, 
and,  if  he  reads  his  lesson  aright,  it  may  serve  to 
keep  him  humble.  ^ 

Too  many  '  quiz '  classes  or  too  much  journal  work 
has  ruined  many  a  promising  clinical  physician. 
While  the  Pythagorean  silence  of  nearly  seven 
years,  which  the  great  Louis  followed  (and  broke 
to  burst  into  a  full-blown  reputation),  cannot  be 
enjoined,  the  young  physician  should  be  careful 
what  and  how  he  writes.  Let  him  take  heed  to 
his  education,  and  his  education  will  take  care  of 
itself,  and  in  a  development  under  the  guidance 
of  seniors  he  will  find  plenty  of  material  for  papers 
before  medical  societies  and  for  publication  in 
scientific  journals.  ^ 


OF    MEDICINE  I79 

Curiously  enough,  the  student-practitioner  may  find  Studious- 

studiousness  a  stumblin£[--block  in  his  career.     A  °^^  ™fy  ^ 

-      J  ,    .      a  stumbling- 

bookish  man  may  never  succeed;  deep-versed  m  block. 

books,  he  may  not  be  able  to  use  his  knowledge 
to  practical  effect;  or,  more  likely,  his  failure  is 
not  because  he  has  studied  books  much,  but  be- 
cause he  has  not  studied  men  more.  He  has  Study  men. 
never  got  over  that  shyness,  that  diflSdence,  against 
which  I  have  warned  you.  I  have  known  instances 
in  which  this  malady  has  been  incurable ;  in  others 
I  have  known  a  cure  effected  not  by  the  public,  but 
by  the  man's  professional  brethren,  who,appreciating 
his  worth,  have  insisted  upon  utilizing  his  mental 
treasures.  ^^ 

It  is  very  hard  to  carry  student  habits  into  a  large  The  student 
city  practice;  only  zeal,  a  fiery  passion,  keeps  the  i^^^ large 
flame  ahve,  smothered  as  it  is  so  apt  to  be  by  the  difficulties, 
dust  and  ashes  of  the  daily  routine.     A  man  may  and  how  he 
be  a  good  student  who  reads  only  the  book  of  ^^e*toem 
nature.      Such  a   one   I   remember  in   the   early 
days  of  my  residence  in  Montreal — a  man  whose  John  Bell.   ^ 
devotion    to    patients   and   whose    kindness    and 
skill  quickly  brought  him  an  enormous  practice. 
Reading    in    his    carriage    and    by   lamplight    at 
Lucina's  bedside,  he  was  able  to   keep  well   in- 
formed ;   but  he  had  an  insatiable  desire  to  know 
the  true  inwardness  of  a  disease,  and  it  was  in 
this  way   I   came  into   contact  with  him.     Hard 
pushed  day   and    night,   yet    he    was   never   too 
busy  to  spend  a  couple  of  hours  with  me  search- 
ing  for  data  which    had    not  been    forthcoming 

N  2 


i8o 


THE    PRACTITIONER 


Quinquen- 
nial brain- 
dusting  an 
essential. 


The  end  of 
the  second 
lustrum. 


during  life,  or  helping  to  unravel  the  mysteries  of 
a  new  disease.  *^ 

The  third  essential  for  the  practitioner  as  a  student 
is  the  quinquennial  brain-dusting,  and  this  will 
often  seem  to  him  the  hardest  task  to  carry  out. 
Every  fifth  year,  back  to  the  hospital,  back  to  the 
laboratory,  for  renovation,  rehabilitation,  rejuvena- 
tion, reintegration,  resuscitation,  &c.  Do  not  forget 
to  take  the  notebooks  with  you,  or  the  sheets,  in  three 
separate  bundles,  to  work  over.  From  the  very 
start  begin  to  save  for  the  trip.  Deny  yourself  all 
luxuries  for  it  .  .  .  Hearken  not  to  the  voice  of  old 
'  Dr.  Hayseed,'  who  tells  you  it  will  ruin  your 
prospects,  and  that  he '  never  heard  of  such  a  thing ' 
as  a  young  man,  not  yet  five  years  in  practice, 
taking  three  months'  holiday.  To  him  it  seems 
preposterous.  Watch  him  wince  when  you  say  it 
is  a  speculation  in  the  only  gold  mine  in  which  the 
physician  should  invest — Grey  Cortex!  What  about 
the  wife  and  babies,  if  you  have  them  .?  Leave  them ! 
Heavy  as  are  your  responsibilities  to  those  nearest 
and  dearest,  they  are  outweighed  by  the  heavier 
responsibilities  to  yourself,  to  the  profession,  and 
to  the  public.  Like  Isaphaena,  the  story  of  whose 
husband — ardent,  earnest  soul,  peace  to  his  ashes ! — 
I  have  told  in  the  little  sketch  oi  An  Alabama 
Student^  your  wife  will  be  glad  to  bear  her  share  in 
the  sacrifice  you  make.  ""^ 

With  good  health  and  good  habits  the  end  of  the 
second  lustrum  should  find  you  thoroughly  estab- 


OF    MEDICINE  l8l 

Ilshed — all  three  rooms  well  furnished,  a  good 
stable,  a  good  garden,  no  mining  stock,  but  a  life 
insurance,  and,  perhaps,  a  mortgage  or  two  on 
neighbouring  farms.  Year  by  year  you  have  dealt 
honestly  with  yourself;  you  have  put  faithfully  the 
notes  of  each  case  into  their  proper  places,  and  you 
will  be  gratified  to  find  that,  though  the  doubtful 
cases  and  mistakes  still  make  a  rather  formid- 
able pile,  it  has  grown  relatively  smaller.  You 
literally  '  own '  the  country-side,  as  the  expression 
is.  All  the  serioois  and  dubious  cases  come  to  you, 
and  you  have  been  so  honest  in  the  frank  acknow- 
ledgement of  your  own  mistakes,  and  so  charitable 
in  the  contemplation  of  theirs,  that  neighbouring 
doctors,  old  and  young,  are  glad  to  seek  your 
advice.  The  work,  which  has  been  very  heavy,  is 
now  lightened  by  a  good  assistant,  one  of  your  own 
•students,  who  becomes  in  a  year  or  so  your  partner. '*^ 

.  .  .  The  cultivated  general  practitioner.     May  this  The  highest 

be  the  destiny  of  a  large  majority  of  you  !     Have  f^^ition— 

no    higher    ambition  !       You    cannot   reach    any  cultivated 

better  position  in  a  community :  the  family  doctor  general 

.  .       practitioner. 

IS  the  man  behind  the  gun,  who  does  our  effective 

work.     That  his  life  is  hard  and  exacting ;  that  he 

is  underpaid  and  overworked ;  that  he  has  but  little 

time  for  study  and  less  for  recreation — these  are  the 

blows  that  may  give  finer  temper  to  his  steel,  and 

bring  out  the  nobler  elements  in  his  character.  *^ 

At  the  outset  I  would  like  to  emphasize  the  fact  Specialism, 
that  the  student  of  internal  medicine  cannot  be  a 


l82 


THE    PRACTITIONER 


The 
pluralist 


The 
specialist. 


Dangers  of 
adopting  a 
speciality 
too  early. 


specialist.  The  manifestations  of  almost  any  one 
of  the  important  diseases  in  the  course  of  a  few 
years  will '  box  the  compass '  of  the  specialities.  ^ 

By  all  means,  if  possible,  let  him  (the  young-  physi- 
cian) be  a  pluralist,  and — as  he  values  his  future 
life — let  him  not  get  early  entangled  in  the  meshes 
of  specialism.  ^ 

There  are  three  lines  of  work  which  he  (the 
young  physician)  may  follow,  all  of  the  most  in- 
tense interest,  all  of  the  greatest  value  to  him — 
chemistry,  physiology,  and  morbid  anatomy.  ^ 

'  That  which  has  been  is  that  which  shall  be.' 

Medicine  may  be  said  to  have  begun  with  special- 
ists. The  Ebers  papyrus  is  largely  taken  up  with 
the  consideration  of  local  diseases,  and  centuries 
later  we  find  in  Greece  certain  individuals  treating 
special  ailments;  and  Aristophanes  satirizes  a 'rectum 
specialist '  in  a  way  not  unlike  our  comic  journals 
would  '  poke  fun '  at  an  oculist  or  an  aurist.  The 
tail  of  our  emblematic  snake  has  returned  into  its 
mouth ;  at  no  age  has  specialism  been  so  rife.  *^ 

A  serious  danger  is  the  attempt  to  manufacture 
rapidly  a  highly  complex  structure  from  ill-seasoned 
material.  The  speedy  success  which  often  comes 
from  the  cultivation  of  a  speciality  is  a  strong  in- 
centive to  young  men  to  adopt  early  a  particular 
line  of  work.     How  frequently  are  we  consulted 


OF    MEDICINE  183     ^ 

by  sucklings  in  our  ranks  as  to  the  most  likely 
branch  in  which  to  succeed,  or  a  student,  with  the 
brazen  assurance  which  only  ignorance  can  give, 
announces  that  he  intends  to  be  a  gynaecologist  or 
an  oculist.  No  more  dangerous  members  of  our 
profession  exist  than  those  born  into  it,  so  to  speak, 
as  specialists.  Without  any  broad  foundation  in 
physiology  or  pathology,  and  ignorant  of  the  great 
processes  of  disease,  no  amount  of  technical  skill  can 
hide  from  the  keen  eyes  of  colleagues  defects  which 
too  often  require  the  arts  of  the  charlatan  to  screen 
from  the  public.  *^ 

The  restriction  of  the  energies  of  trained  students  Specialism, 
to  narrow  fields  in  science,  whUe  not  without  its 
faults,  has  been  the  most  important  single  factor 
in  the  remarkable  expansion  of  our  knowledge. 
Against  the  disadvantages  in  a  loss  of  breadth  and 
harmony  there  is  the  compensatory  benefit  of  a 
greater  accuracy  in  the  apphcation  of  knowledge 
in  specialism,  as  is  well  illustrated  in  the  cultivation 
of  special  branches  of  practice.  ^ 

Dentistry,  ophthalmology,  and  gynaecology  are 
branches  which  have  been  brought  to  a  state  of 
comparative  perfection,  and  very  largely  by  the 
labours  of  American  physicians.  ^ 

The  advantages  to  the  profession  which  followed  Advantages 

this  differentiation  have  nowhere  been  more  striking-  ?  ^P®<^^- 

ism. 
than  m  this  country,  and  the  earnest  workers  in  oph- 
thalmology, gynaecology,  dermatology,  and  other 


164 


THE    PRACTITIONER 


branches  have  contributed  largely  to  inculcate  the 
idea  of  thoroughness,  the  necessity  for  which  is  apt 
to  be  lost  sight  of  in  the  hurry  and  bustle  incident 
to  the  growth  of  a  nation.  Better  work  is  done  all 
along  the  line  :  a  shallow  diffuseness  has  given 
place  to  the  clearness  and  definiteness  which  comes 
from  accurate  study  in  a  limited  field.  The  day 
has  gone  by  for  Admirable  Crichtons,  and  although 
we  have  a  few  notable  illustrations  in  our  ranks  of 
men  who  have  become  distinguished  authorities  in 
eye  and  skin  diseases,  and  upon  syphilis,  without 
sacrificing  their  interests  in  general  surgery,  such 
are  necessarily  rare,  and,  unfortunately,  from  the 
very  circumstances  of  the  case,  likely  to  become 
more  uncommon.  Then  how  comforting  to  the 
general  practitioner  is  the  wise  counsel  of  the 
specialist.  We  take  him  a  case  that  has  puzzled 
and  annoyed  us,  the  diagnosis  of  which  is  uncertain, 
and  we  consult  in  vain  the  unwritten  records  of  our 
experience  and  the  printed  records  of  our  books. 
He  labels  it  in  a  few  minutes  as  a  coleopterist  would 
a  beetle,  and  we  feel  grateful  for  the  accuracy  of 
his  information,  and  happy  in  the  possession  of  the 
label.  And  if  sometimes  (standing  like  Aaron 
between  life  and  death)  he  illumines  too  brightly 
the  darkness  of  our  ignorance,  are  we  not  as  often 
beholden  to  him  for  gentle  dealing .''  *^ 

The  public  It   is  almost  unnecessary  to   remark  that    the 

and  special-  public,  in  which  we  live  and  move,  has  not  been 
slow  to  recognize  the  advantage  of  a  division  of 
labour  in  the  field  of  medicine.     The  desire  for 


ism. 


OF    MEDICINE  185 

expert  knowledge  is,  however,  now  so  general  that 
there  is  a  grave  danger  lest  the  family  doctor 
should  become,  in  some  places,  a  relic  of  the  past. 
It  must,  indeed,  be  a  comfort  to  thousands  to  feel 
that  in  the  serious  emergencies  of  life  expert  skill 
is  now  so  freely  available.  *^ 

Perhaps,  as  specialists,  no  class  in  our  profession  has  The  gjmae- 
been  more  roundly  abused  for  meddlesome  work  cologisL 
than  the  gynaecologists,  and  yet  what  shall  not  be 
forgiven  to  the  men  who,  as  a  direct  outcome  of 
the  very  operative  details  which  have  received  the 
bitterest  criticism,  have  learned  to  recognize  tubal 
gestation,  and  are  to-day  saving  lives  which  other- 
wise would  inevitably  have  been  lost }  In  one  year 
at  the  Philadelphia  Pathological  Society,  Formad 
has  shown  ten  or  twelve  examples  of  ruptured 
tubal  pregnancy  obtained  in  medico-legal  work 
(sudden  deaths)  in  that  city.  The  benefits  which 
the  public  reap  from  specialism  may  be  gathered 
from  the  fact  that  in  a  not  much  longer  period  of 
time  I  have  seen  seven  specimens  of  tubal  gestation, 
not  removed  by  the  pathologist,  but  by  the  gynae- 
cologist, with  the  saving  of  five  lives.  The  con- 
servatism, which  branded  ovariotomists  as  butchers 
and  belly-rippers,  is  not  yet  dead  among  us,  and 
I  say  it  frankly,  to  our  shame,  that  it  has  not 
always  been  professional  encouragement,  which  has 
supported  the  daring  advances  on  special  lines. 
Humanity  owes  a  great  debt  of  gratitude  to  the 
devoted  men  who  have  striven  during  the  past  half- 
century  for  exactness  in  knowledge,  and  for  its 


i86 


THE   PRACTITIONER 


The  special- 
ist; bis 
dangers. 


and  how  he 
may  avoid 
them. 


Dangers  of 
specialism. 


practical  application  in  all  departments,  a  debt  too 
great  to  pay,  too  great,  one  sometimes  feels,  even 
to  acknowledge.  *^ 

Next  to  the  danger  from  small  men  is  the  serious 
risk  of  the  loss  of  perspective  in  prolonged  and 
concentrated  effort  in  a  narrow  field.  Against 
this  there  is  but  one  safeguard — the  cultivation  of 
the  sciences  upon  which  the  speciality  is  based. 
The  student-specialist  may  have  a  wide  vision — no 
student  wider — if  he  gets  away  from  the  mechanical 
side  of  the  art,  and  keeps  in  touch  with  the  physio- 
logy and  pathology  upon  which  his  art  depends. 
More  than  any  of  us,  he  needs  the  lessons  of 
the  laboratory,  and  wide  contact  with  men  in 
other  departments  may  serve  to  correct  the  in- 
evitable tendency  to  a  narrow  and  perverted 
vision,  in  which  the  life  of  the  ant-hill  is  mistaken 
for  the  world  at  large.  ^^ 

Specialism  is  not,  however,  without  many  dis- 
advantages. A  radical  error  at  the  outset  is  the 
failure  to  recognize  that  the  results  of  specialized 
observation  are  at  best  only  partial  truths,  which 
require  to  be  correlated  with  facts  obtained  by 
wider  study.  The  various  organs,  the  diseases  of 
which  are  subdivided  for  treatment,  are  not  isolated, 
but  complex  parts  of  a  complex  whole,  and  every 
day's  experience  brings  home  the  truth  of  the 
saying, '  When  one  member  suffers  all  the  members 
suffer  with  it.'  Plato  must  have  discussed  this  very- 
question  with  his  bright  friends  in  the  profession — 


OF   MEDICINE  187 

Eryxlmachus,  perhaps — or  he   never  could  have 
put  the  following  words  in  the  mouth  of  Socrates: — 

*I  dare  say  that  you  may  have  heard  eminent 
physicians  say  to  a  patient  who  comes  to  them 
with  bad  eyes,  that  they  cannot  cure  the  eyes  by 
themselves,  but  that  if  his  eyes  are  to  be  cured,  his 
head  must  be  treated  :  and  then  again  they  say  that 
to  think  of  curing  the  head  alone  and  not  the  rest 
of  the  body  also,  is  the  height  of  folly.  And 
arguing  in  this  way  they  apply  their  methods  to 
the  whole  body,  and  try  to  treat  and  heal  the  whole 
and  the  part  together.  Did  you  ever  observe  that 
this  is  what  they  say  ? '  * 

A  sentence  which  embodies  the  law  and  the  gospel 
for  specialists.  *^ 

In  the  cultivation  of  a  speciality  as  an  art  there  is  The  narrow 

a  tendency   to   develop    a   narrow    and    pedantic  f;ndpedan. 
•^  ^  .  '^  tic  special- 

spirit  ;   and  the  man  who,  year  in  and  year  out,  ists. 

examines  eyes,  palpates  ovaries,  or  tunnels  urethrae, 

without  regard  to  the  wider  influences  upon  which 

his  art  rests,  is  apt,  insensibly  perhaps,  but  none 

the  less  surely^  to  acquire  the  attitude  of  mind  of 

the  old  Scotch  shoemaker,  who,  in  response  to  the 

Dominie's  suggestions  about  the  weightier  matters 

of  life,  asked, '  D'ye  ken  leather  ? '  ^^ 

Problems  in  physiology  and  pathology  touch  at  Advantages 

every  point  the  commonest  affections ;  and  exercised  °f  ^^^^l^  °* 

.  .  physiology 

in  these,  if  only  in  the  early  years  of  professional  and  patho- 

life,  the  man  is  chastened,  so  to  speak,  and  can  logy  to  the 

specialist 

*  Charmides :  Jowett's  translation. 


i88 


THE    PRACTITIONER 


Education 
and  the 
specialist 


never,  even  in  the  daily  round  of  the  most  exacting 
practice,  degenerate  into  a  money-making  machine. 
And  let  the  younger  of  my  hearers  lay  this  to 
heart:  scan  the  lives  of  say  twenty  of  the  men 
most  prominent  in  special  lines  of  medicine  and 
surgery  to-day  in  this  country,  and  you  will  find, 
with  scarcely  an  exception,  the  early  years  de- 
voted to  anatomical,  physiological,  or  pathological 
studies.  They  rose  high  because  the  foundations 
were  deep.  The  most  distinguished  oculists  have 
been  men  trained  in  physiology  and  pathology ;  and 
some,  like  Sir  William  Bowman,  have  had  reputa- 
tions so  pre-eminent  in  several  departments  that 
the  identity  of  the  physiologist  has  been  lost  in  the 
ophthalmologist.  *^ 

Very  little  additional  knowledge  enables  the  general 
practitioner  to  grapple  with  a  large  proportion  of 
the  cases  which  in  cities  come  under  the  care  of  the 
specialist.  The  question  resolves  itself  into  one  of 
education.  It  is  impossible  in  three  sessions  to 
bring  men  beyond  the  superficial  routine,  but  in 
a  more  prolonged  course — as  I  know  from  ex- 
perience— the  student  can  be  taught  practically, 
in  the  wards  and  dispensaries,  enough  of  the  tech- 
nique of  the  specialist  to  give,  at  least,  a  foundation 
upon  which  to  work.  He  should  leave  the  schools 
knowing  the  practical  application  of  the  micro- 
scope, the  ophthalmoscope,  and  the  laryngoscope, 
and  in  these  and  other  lines  he  should  have  pro- 
ceeded to  the  stage  in  which  he  recognizes  the 
limitations  of  his  knowledge.     Such    a  man,   in 


OF   MEDICINE  189 

general  practice,  should  know  a  '  choked  disk  '  ; 
the  examination  for  tube-casts  should  be  a  familiar, 
everyday  task ;  and  he  should  be  able  to  tell 
whether  a  vocal  chord  was  paralysed.  A  serious 
obstacle  to  this  happy  consummation — which  can 
be  reached  in  a  well-ordered  system  of  education — 
is  the  absence,  in  the  early  years  of  practice,  of 
material  upon  which  to  freshen  the  memory  and  to 
'  keep  the  hand  in  ' ;  but  the  man  who,  as  a  student, 
has  reached  a  certain  point  always  retains  some 
measure  of  the  old  facility.  The  post-graduate 
schools  have  done  much  to  enable  men  to  revive, 
and  to  acquire,  technical  skill,  and  have  been  of 
great  service  in  generalizing  special  knowledge. 
In  the  practice  of  a  good,  all-round  man,  the  num- 
ber of  cases  demanding  the  help  of  a  specialist  is, 
after  all,  not  great.  The  ordinary  run  of  nervous 
disorders  should  be  recognized  ;  adenoid  vegetations 
he  would  treat  with  the  skill  of  a  laryngologist ; 
he  would  know  enough  not  to  tinker  with  a  case 
of  glaucoma ;  and  though  he  might  not  diagnose 
a  pus-tube  from  tubal  gestation,  he  would  (in  this 
as  in  other  details)  have  learned  to  know  his  limits 
and  be  ready  to  seek  further  advice.  '*^ 

The  organization  of  societies  for  the  study  of  par-  The  special- 

ticular  diseases  has  been  of  late  a  very  notable  societies 

feature   in    the   professional   life  of  this   country. 

Since  the  foundation  of  the  Ophthalmological  Society 

more  than  a  dozen  associations  have  been  formed, 

and  their  union  in  a  triennial  congress  has  proved 

a  remarkable  success.     These  societies   stimulate 


igo 


THE    PRACTITIONER 


Diagnosis, 
not  drug- 
ging. 


New  school 
ot  medicine. 


work,  promote  good  fellowship,  and  aid  materially 
in  maintaining-  the  standard  of  professional  scholar- 
ship. They  are  nearly  all  exclusive  bodies,  limited 
in  membership,  and  demanding  for  admission  evi- 
dence of  special  fitness.  This  point  is  sometimes 
urged  against  them  ;  but  the  members  exercise  no 
arbitrary  privilege  in  asking  of  candidates  familiarity 
with  the  subject,  and  evidence  of  ability  to  contri- 
bute to  the  general  store  of  knowledge.  In  some 
of  the  specialities  these  societies  have  been  particu- 
larly useful  in  disciplining  men  who  have  traduced, 
not  the  code,  but  the  unwritten  traditions  of  our 
craft,  acting  as  if  they  were  venders  of  wares  to  be 
hawked  in  the  market-place.  ^^ 

In  the  fight  which  we  have  to  wage  incessantly 
against  ignorance  and  quackery  among  the  masses, 
and  follies  of  all  sorts  among  the  classes,  diagnosis, 
not  drugging,  is  our  chief  weapon  of  offence. 
Lack  of  systematic  personal  training  in  the  methods 
of  the  recognition  of  disease  leads  to  the  mis- 
application of  remedies,  to  long  courses  of  treat- 
ment when  treatment  is  useless,  and  so  directly 
to  that  lack  of  confidence  in  our  methods  which 
is  apt  to  place  us  in  the  eyes  of  the  public  on  a  level 
with  empirics  and  quacks.  ''^ 

The  nineteenth  century  has  witnessed  a  revolution 
in  the  treatment  of  disease,  and  a  growth  of  a  new 
school  of  medicine.  The  old  schools — regular  and 
homoeopathic — put  their  trust  in  drugs,  to  give 
which  was  the  alpha  and  omega  of  their  practice. 


OF    MEDICINE  191 

For  every  symptom  there  were  a  score  or  more  of 
medicines — vile,  nauseous  compounds  in  one  case ; 
bland,  harmless  dilutions  in  the  other.  The  charac- 
teristic of  the  new  school  is  firm  faith  in  a  few 
good,  well-tried  drugs,  little  or  none  in  the  great 
mass  of  medicines  still  in  general  use.  ^ 

Imperative  drugging — the  ordering  of  medicine 
in  any  and  every  malady — is  no  longer  regarded  as 
the  chief  function  of  the  doctor.  ^ 

The  battle  against  polypharmacy,  or  the  use 
of  a  large  number  of  drugs  (of  the  action  of  which 
we  know  little,  yet  we  put  them  into  bodies  of  the 
action  of  which  we  know  less),  has  not  been  brought 
to  a  finish.  ^ 

One  of  the  most  striking  characteristics  of  the 
modern  treatment  of  disease  is  the  return  to  what 
used  to  be  called  the  natural  methods — diet,  exercise, 
bathing,  and  massage.  There  probably  never  has 
been  a  period  in  the  history  of  the  profession  when 
the  value  of  diet  in  the  prevention  and  the  cure 
of  disease  was  more  fully  recognized.  ^ 

AU  this  change  (from  empiricism  to  science)  has  Facts, 
come  about  by  the  observation  of  facts,  by  their 
classification,   and  by    the    founding    upon   them 
of  general  laws.  ^^ 

Emulating  the  persistence  and  care  of  Darwin, 
we  must  collect  facts  with  open-minded  watchful- 


192 


THE    PRACTITIONER 


The  home 
laboratory. 


Man's  im- 
mutability, 


and  his 
mutability. 


ness,  unbiased  by  crotchets  or  notions  ;  fact  on 
fact,  instance  on  instance,  experiment  on  experi- 
ment ;  facts  which  fitly  jointed  together  by  some 
master  who  grasps  the  idea  of  their  relationship, 
may  establish  a  general  principle.  ^^ 

A  room  fitted  as  a  small  laboratory,  with  the 
necessary  chemicals  and  a  microscope,  will  prove 
a  better  investment  in  the  long  run  than  a  static 
machine  or  a  new-fangled  air-pressure  spray 
apparatus.  '^ 

The  history  of  the  race  is  a  grim  record  of  passions 
and  ambitions,  of  weaknesses  and  vanities,  a  record, 
too  often,  of  barbaric  inhumanity ;  and  even  to- 
day, when  philosophers  would  have  us  believe 
man's  thoughts  had  widened,  he  is  ready  as  of  old 
to  shut  the  gates  of  mercy,  and  to  let  loose  the 
dogs  of  war.  '"* 

Our  study  is  man,  as  the  subject  of  accidents  or 
diseases.  Were  he  always,  inside  and  outside,  cast 
in  the  same  mould,  instead  of  differing  from  his 
fellow  man  as  much  in  constitution  and  in  his  re- 
action to  stimulus  as  in  feature,  we  should  ere  this 
have  reached  some  setded  principles  in  our  art.  " 

And  not  only  are  the  reactions  themselves  vari- 
able, but  we,  the  doctors,  are  so  fallible,  ever  beset 
with  the  common  and  fatal  facility  of  reaching 
conclusions  from  superficial  observations,  and  con- 


OF    MEDICINE  I93 

stantly  misled  by  the  ease  with  which  our  minds 
fall  into  the  rut  of  one  or  two  experiences. " 

I  suppose,  as  a  body,  clergymen  are  better  edu-  The  clergy 
cated  than  any  other,  yet  they  are  notorious  ^^"P  5^*^ 
supporters  of  all  the  nostrums  and  humbuggery 
with  which  the  daily  and  religious  papers  abound  ; 
and  I  find  that  the  further  away  they  have  wan- 
dered from  the  decrees  of  the  Council  of  Trent, 
the  more  apt  are  they  to  be  steeped  in  thaumaturgic 
and  Galenical  superstition.  ^^ 

But  know  also,  man  has  an  inborn  craving  for  Man— a 
medicine.     Heroic  dosing  for  several  generations  ™^^"°^' 
has  given  his  tissues  a  thirst  for  drugs.      As  I  once  animal, 
before  remarked,  the  desire  to  take  medicine  is  one 
feature  which  distinguishes  man,  the  animal,  from 
his  fellow  creatures.      It  is  really  one  of  the  most 
serious  difficulties  with  which  we  have  to  contend. 
Even   in    minor  ailments,  which  would  yield  to 
dieting  or  to  simple  homfe  remedies,  the  doctor's 
visit  is  not  thought  to  be  complete  without  the 
prescription.  ^^ 

And  now  that  the  pharmacists  have  cloaked  even  piiis  and 
the  most  nauseous  remedies,  the  temptation  is  to  Potio^s. 
use  medicine  on  every  occasion  ;  and  I  fear  that 
we  may  return  to  the  state  of  polypharmacy,  the 
emancipation  from  which  has  been  the  sole  gift 
of  Hahnemann  and  his  followers  to  the  race.  As 
the  public  becomes  more  enlightened,  and  as  we 
get  more  sense,  dosing  will  be  recognized  as  a  very 

O 


194 


THE    PRACTITIONER 


The  practi- 
tioner's 
foes — 
the  border- 
land phar- 
maceutical 
houses. 


minor  function  in  the  practice  of  medicine  in  com- 
parison with  the  old  measures  of  Asclepiades.  '^ 

It  may  keep  the  practitioner  out  of  the  clutches  of 
the  arch-enemy  of  his  professional  independence — 
the  pernicious   literature   of  our   camp-followers, 
a  literature    increasing-  in    bulk,   in   meretricious 
attractiveness,    and    in    impudent    audacity.      To 
modern  pharmacy  we   owe   much,  and  to   phar- 
maceutical methods  we  shall  owe  much  more  in 
the  future,  but  the  profession  has  no  more  insidious 
foe  than  the  large  borderland  pharmaceutical  houses. 
No  longer  an  honoured  messmate,  pharmacy  in 
this  form  threatens  to   become  a   huge  parasite, 
eating   the   vitals   of  the  body  medical.     We  all 
know  too  well  the  bastard  literature  which  floods 
the  mail,  every  page  of  which  illustrates  the  truth 
of  the  axiom,  the  greater  the  ignorance  the  greater 
the  dogmatism.     Much  of  it  is  advertisements  of 
nostrums  foisted  on  the  profession  by  men  who 
trade   on    the   innocent   credulity   of  the   regular 
physician,  quite  as  much  as  any  quack  preys  on 
the  gullible  public.     Even  the  most  respectable 
houses  are  not   free  from   this   sin   of  arrogance 
and   of   ignorant  dogmatism   in    their   literature. 
A  still  more  dangerous  enemy  to  the  mental  virility 
of  the  general  practitioner  is   the  '  drummer '   of 
the  drug-house.     While  many  of  them  are  good, 
sensible  fellows,  there  are  others,  voluble  as  Cassio, 
impudent  as  Autolycus,  and  senseless  as  Caliban, 
who  will  tell  you  glibly  of  the  virtues  of  the  extract 
of  the  coccygeal  gland  in  promoting  pineal  meta- 


OF    MEDICINE  I95 

bolism,  and  ready  to  express  the  most  emphatic 
opinions  on  questions  about  which  the  greatest 
masters  of  our  art  are  doubtful.  No  class  of  men 
with  which  we  have  to  deal  illustrates  more  fully 
the  greatest  of  ignorance,  which  is  the  conceit  that 
a  man  knows  what  he  does  not  know.  ^^ 

I  am  often  asked — Why  have  you  not  tried  the  Pseudo- 

W treatment  ?    As  well  ask  why  do  I  not  use  science. 

Bishop     Berkeley's    Tar-water.      Any    intelligent 

physician  who  reads  Dr.  W 's  articles  in  the 

journals,  or  as  they  have  been  collected  in  his  book, 
must  be  impressed — first,  with  the  crude,  unscientific 
character  of  his  work,  and  of  the  ignorance  every- 
where displayed  of  the  nature  of  typhoid  fever ; 
and,  secondly,  with  the  persistent  vaunting  of  a 

specific  or   cure-all.      Dr.   W is   a  devoted, 

earnest  man,  who  honestly  believes  in  his  plan — so 
did  Bishop  Berkeley  in  his — but  until  the  presenta- 
tion has  been  made  in  a  different  way,  I  can  no 
more  accept  his  statements  than  those  of  any  other 
misguided  enthusiast  who  has  been  fortunate  enough 
to  have  his  wares  exploited  in  the  profession  by 
a  drug- house  of  repute.  That  any  firm  should 
have  lent  their  name  to  this  '  treatment,'  that  they 
should  have  spread  broadcast  in  the  profession 
its  literature,  may  have  been  good  business  policy, 
but  displays  a  sad  lack  of  judgement.  On  such 
a  question  it  is  much  easier  to  keep  silence  than  to 
speak  one's  mind  frankly  in  what  may  appear  an 
ungracious,  unkindly  way  ;  but  I  am  quite  ready 
to  express  this  opinion  in  public,  since  I  have  had 
O  2 


196  THE    PRACTITIONER 

SO  often  to  do  it  in  private,  in  response  to  scores  of 
letters  from  physicians  in  different  parts  of  the 
country.  To  one  who  appreciates  what  those 
great  masters,  Nathan  Smith,  James  Jackson, 
W.  W.  Gerhard,  Elisha  Bartlett,  and  Austin  Flint, 
did  in  this  country  for  the  elucidation  of  typhoid 

fever,  the  book  itself  issued  by  Dr.  W is  a 

reflection  on  the  memory  of  men  whose  works  and 
ways  are  alike  our  standard  and  our  pride.  ^^ 

The  danger  Now,  while  nothing  disturbs  our  mental  placidity 
Ufe^^*'"^^  more  sadly  than  straitened  means,  and  the  lack 
of  those  things  after  which  the  Gentiles  seek, 
I  would  warn  you  against  the  trials  of  the  day  soon 
to  come  to  some  of  you — the  day  of  large  and 
successful  practice.  .  .  .  Engrossed  late  and  soon 
in  professional  cares,  getting  and  spending,  you 
may  so  lay  waste  your  powers  that  you  may  find, 
too  late,  with  hearts  given  away,  that  there  is 
no  place  in  your  habit-stricken  souls  for  those 
gentler  influences  which  make  life  worth  living.  ^° 

The  busy        Greater  sympathy  must  be  felt  for  the  man  who 
doctor.  jj^  started  all  right  and  has  worked  hard  at  the 

societies,  but  as  the  rolling  years  have  brought 
ever-increasing  demands  on  his  time,  the  evening 
hours  find  him  worn  out,  yet  not  able  to  rest,  much 
less  to  snatch  a  little  diversion  or  instruction  in  the 
company  of  his  fellows  whom  he  loves  so  well.  Of 
all  men  in  the  profession  the  forty-visit-a-day  man 
is  the  most  to  be  pitied.     Not  always  an  automaton, 


OF    MEDICINE  197 

he  may  sometimes  by  economy  of  words  and  extra- 
ordinary energy  do  his  work  well,  but  too  often  he 
is  the  one  above  all  others  who  needs  the  refresh- 
ment of  mind  and  recreation  that  is  to  be  had 
in  a  well-conducted  society.  Too  often  he  is  lost 
beyond  all  recall,  and,  Hke  Ephraim  joined  to  his 
idols,  we  may  leave  him  alone.  Many  good  men 
are  ruined  by  success  in  practice,  and  need  to  pray 
the  prayer  of  the  Litany  against  the  evils  of  pros- 
perity. It  is  only  too  true,  as  you  know  well,  that 
a  most  successful — as  the  term  goes — doctor  may 
practise  with  a  clinical  slovenliness  that  makes  it 
impossible  for  that  kind  old  friend.  Dame  Nature, 
to  cover  his  mistakes,  A  well-conducted  society 
may  be  of  the  greatest  help  in  stimulating  the 
practitioner  to  keep  up  habits  of  scientific  study. 
It  seems  a  shocking  thing  to  say,  but  you  all  know 
it  to  be  a  fact,  that  many,  very  many,  men  in  large 
practice  never  use  a  stethoscope,  and  as  for  a 
microscope,  they  have  long  forgotten  what 
a  leucocyte  or  a  tube-cast  looks  like.  This  in 
some  cases  may  be  fortunate,  as  imperfect  or  half- 
knowledge  may  only  lead  to  mistakes,  but  the 
secret  of  this  neglect  of  means  of  incalculable  help 
is  the  fact  that  he  has  not  attained  the  full  and 
enduring  knowledge  which  should  have  been  given 
to  him  in  the  medical  school.  It  is  astonishing 
with  how  little  outside  aid  a  large  practice  may  be 
conducted,  but  it  is  not  astonishing  that  in  it  cruel 
and  unpardonable  mistakes  are  made.  At  whose 
door  so  often  lies  the  responsibility  for  death  in 
cases  of  empyema  but  at  that  of  the  busy  doctor, 


198 


THE    PRACTITIONER 


who  has  not  time  to  make  routine  examinations,  or 
who  is  '  so  driven '  that  the  urine  of  his  scarlet 
fever  or  puerperal  patients  is  not  examined  until 
the  storm  has  broken  ?  '^ 

The  general  The  peril  is  that  should  he  (the  physician)  cease  to 
practitioner:  ^jij^k  for  himself  he  becomes  a  mere  automaton, 
doing  a  penny-in-the-slot  business  which  places 
him  on  a  level  with  the  chemist's  clerk  who  can 
hand  out  specifics  for  every  ill,  from  the  '  pip ' 
to  the  pox.  ^^ 


the  best  pro- 
duct of  our 
profession. 


Dangers  of 
prosperity. 


Politics. 


With  an  optimistic  temperament  and  a  good 
digestion  he  is  the  very  best  product  of  our  pro- 
fession, and  may  do  more  to  stop  quackery  and 
humbuggery,  inside  and  outside  of  the  ranks,  than 
could  a  dozen  prosecuting  county  attorneys.  Nay 
more  !  such  a  doctor  may  be  a  daily  benediction  in 
the  community — a  strong,  sensible,  whole-souled 
man,  living  a  life  often  of  great  self-denial,  always  of 
tender  sympathy,  worried  neither  by  the  vagaries 
of  the  well  nor  by  the  testy  waywardness  of  the  sick, 
and  to  him,  if  to  any,  may  come  (even  when  he 
knows  it  not)  the  true  spiritual  blessing — that '  bless- 
ing which  maketh  rich  and  addeth  no  sorrow.' 

The  danger  in  such  a  man's  life  comes  with 
prosperity.  He  is  safe  in  the  hard-working  day, 
when  he  is  cHmbing  the  hill,  but  once  success  is 
reached,  with  it  come  the  temptations  to  which 
many  succumb.  Politics  has  been  the  ruin  of  many 
country  doctors.  .  .  .  He  is  popular ;  he  has  a  little 


OF   MEDICINE  I99 

money;  and  he,  if  anybody,  can  save  the  seat  for  the 

party.     When  the  committee  leaves  you,  take  the 

offer  under  consideration,  and  if  in  the  ten  or  twelve 

years  you  have  kept  on  intimate  terms  with  those 

friends  of  your  student  days,  Montaigne  and  Plutarch, 

you  will  know  what  answer  to  return.     If  you  live  Opening  a 

in   a  large   town,  resist  the   temptation   to   open  sanatorium. 

a  sanatorium.     It  is  not  the  work  for  a  general 

practitioner,   and  there  are  risks   that  you   may 

sacrifice  your  independence  and  much  else  besides. 

And,  thirdly,  resist  the  temptation  to  move  into  a  Moving  to  a 

larger  place.     In  a  good  agricultural  district,  or  in  l^S^^  place. 

a  small  town,  if  you  handle  your  resources  aright, 

taking  good  care  of  your  education,  of  your  habits, 

and  of  your  money,  and  devoting  part  of  your 

energies  to  the  support  of  the  societies,  &c.,  you 

may  reach  a  position  in  the  community  of  which 

any    man    may    be    proud.      There   are    country 

practitioners  among  my  friends  with  whom  I  would 

rather  change  places  than  with  any  in  our  ranks, 

men   whose   stability   of  character  and  devotion 

to    duty    make    one    proud    of    the    profession. 

As  I  have  said  before,  have  no  higher  ambition 

than  to  become  an  all-round  family  doctor,  whose 

business  in  life  is  to  know  disease  and  to  know  how 

to  treat  it.  ^^ 


Last  year  I  was  called  to  a  town  in  Pennsylvania,  The 
and  having  to  wait  until  late  in  the  evening  for  the  routinist. 
return  train,  I  insisted,  as  is  my  wont,  that   the 
medical  man  should  carry  on  his  daily  work  and 


200  THE    PRACTITIONER 

allow  me  to  help  if  possible.  An  afternoon  round 
among  people  chiefly  of  the  mechanic  class,  showed 
me  a  shrewd,  cheery  man,  who  in  twenty  years  had 
gained  the  confidence  and  esteem  of  his  patients. 
Kindly,  hopeful  words,  very  sensible  advice  about 
diet,  and  some  half-dozen  drugs  seemed  the  essentials 
in  his  practice.  In  the  evening  I  saw  him  dispose 
of  a  dozen  patients  at  an  outdoor  dispensary  rate ; 
the  examination  was  limited  to  the  pulse,  the  tongue, 
and  sometimes  the  throat.  The  dispensing,  which  was 
of  the  most  primitive  sort,  was  done  at  the  table,  on 
which  stood  four  or  five  tins  and  paper  boxes  con- 
taining large  quantities  of  calomel,  soda,  antipyrin, 
and  Dover's  powder.  Other  drugs,  he  said,  were 
rarely  necessary.  He  never  used  a  stethoscope  ;  he 
had  no  microscope  or  instruments  of  precision  other 
than  the  thermometer.  In  reply  to  my  questions  he 
said  that  he  rarely  had  to  make  an  examination. 
'  If  the  patient  has  fever  I  send  him  to  bed,  if  there 
is  oedema  I  ask  for  the  urine.  Of  course,  I  make 
many  mistakes,  and  I  sometimes  get  caught,  but 
not  oftener  than  the  other  fellows,  and  when  I  am 
in  serious  doubt  I  ask  for  a  consultation.'  This 
was  a  man  of  parts,  a  graduate  from  a  good  school, 
but  early  in  his  career  he  had  become  very  busy» 
and  gaining  the  confidence  of  the  people,  and  having 
much  confidence  in  himself,  he  had  unconsciously 
got  into  a  rut,  out  of  which  at  forty  only  one  thing 
could  lift  him — a  prolonged  course  of  additional 
study.  This  is  by  no  means  an  exaggerated  picture 
of  a  routinist  in  general  practice.  We  aU  have  our 
therapeutic  ruts,  and  we  all  know  consultants  from 


OF    MEDICINE  201 

whom  patients  find  it  very  difficult  to  escape  with- 
out their  favourite  prescription,  no  matter  what  the 
malady  may  be.  Men  of  this  stamp  gain  a  certain 
measure  of  experience,  and  if  of  a  practical  turn  of 
mind  may  become  experts  in  mechanical  procedures, 
but  to  experience  in  the  true  sense  of  the  word 
they  never  attain.  In  reality  they  suffer  from  the 
all-prevailing-  vice  of  intellectual  idleness.  It  is  so 
much  easier  to  do  a  penny-in-the-slot  sort  of  practice, 
in  which  each  symptom  is  at  once  met  with  its 
appropriate  drug,  than  to  make  a  careful  examina- 
tion and  really  to  study  the  case  systematically. 
Much  depends  upon  a  man's  mental  constitution, 
but  much  more  on  the  sort  of  training  he  has  had. 
If,  when  a  student,  good  methods  are  not  acquired, 
it  is  very  hard  to  get  into  proper  habits  of  work  in 
practice.  * 

The  rationalist,  on  the  other  hand,  always  ap-  The 
proaches  a  patient  as  a  mathematician  does  a  rationalist 
problem.  There  is  something  to  be  found  out ;  in 
each  case,  however  trivial,  there  is  something  novel ; 
and  the  problem  of  causation  and  the  question  of 
relief,  while  not  perhaps  of  equal  importance,  are 
of  equal  interest.  He  may  be  just  as  busy  as  his  care- 
less brother,  but  he  finds  time  to  keep  up  a  technical 
dexterity  in  the  use  of  instruments  of  precision, 
and  the  stethoscope  and  the  microscope  are  daily 
helps  in  diagnosis.  These  men  are  the  delight  of 
the  consultant.  To  go  into  the  country  and  find 
the  diagnosis  is  made  a  case  of  mitral  stenosis, 
a  Friedrich's  ataxia,  a  case  of  leukaemia,  or  one  of 


202 


THE    PRACTITIONER 


Routine. 


Experience 
and  the 
general 
practitioner. 


The  man 
•who  does 
not  read. 


myxoedema  gives  a  man  a  thrill  of  pleasure  such 
as  Comte  says  he  always  felt  when  a  student  gave 
him  an  intelligent  set  of  answers  in  an  examination. 
It  is  this  class  of  practitioners  for  whom  the  post- 
graduate courses  are  helpful  and  necessary.  They 
alone  feel  the  need  of  keeping  abreast  of  the  times, 
and  men  of  this  type  will  return  every  few  years, 
finding  that  a  few  months'  course  of  study  not  only 
improves  and  helps  them  personally,  but  is  most 
beneficial  in  their  practice.  ^ 

In  institutions  the  corroding  effect  of  routine  can 
be  withstood  only  by  maintaining  high  ideals  of 
work ;  but  these  become  the  sounding  brass  and 
tinkling  cymbals  without  corresponding  sound 
practice.  ^^ 

For  the  general  practitioner  a  well-used  library 
is  one  of  the  few  correctives  of  the  premature 
senility  which  is  so  apt  to  overtake  him.  Self- 
centred,  self-taught,  he  leads  a  solitary  life,  and 
unless  his  everyday  experience  is  controlled  by 
careful  reading,  or  by  the  attrition  of  a  medical 
society,  it  soon  ceases  to  be  of  the  slightest  value, 
and  becomes  a  mere  accretion  of  isolated  facts, 
without  correlation. '' 

<^ 
It  is  astonishing-  with  how  little  reading-  a  doctor 
can  practise  medicine,  but  it  is  not  astonishing  how 
badly  he  may  do  it.  Not  three  months  ago  a 
physician  living  within  an  hour's  ride  of  the  Surgeon- 
General's  Library  brought  to  me  his  little  girl  aged 


OF    MEDICINE  203 

twelve.  The  diagnosis  of  infantile  mjrxoedema 
required  only  a  half-glance.  In  placid  contentment 
he  had  been  practising  twenty  years  in  '  Sleepy 
Hollow,'  and  not  even  when  his  own  flesh  and  blood 
was  touched  did  he  rouse  from  an  apathy  deep  as 
Rip  Van  Winkle's  sleep.  In  reply  to  questions : 
No,  he  had  never  seen  anything  in  the  journals 
about  the  thyroid  gland ;  he  had  seen  no  pictures 
of  cretinism  or  myxoedema ;  in  fact,  his  mind  was 
a  blank  on  the  whole  subject.  He  had  not  been 
a  reader,  he  said,  but  he  was  a  practical  man  with 
very  little  time.  '^ 

The  physician,  like  the  Christian,  has  three  great  Ignorance, 
foes — ignorance^  which  is  sin ;  apathy^  which  is  the  apathy,  and 
world  ;  and  vice,  which  is  the  devil.  There  is  a  de-  ignorance, 
lightful  Arabian  proverb,  two  lines  of  which  run : 
'  He  who  knows  not,  and  knows  not  that  he  knows 
not,  is  a  fool.  Shun  him.  He  who  knows  not,  and 
knows  that  he  knows  not,  is  simple.  Teach  him.' 
To  a  large  extent  these  two  classes  represent  the 
people  with  whom  we  have  to  deal.  Teaching 
the  simple  and  suffering  the  fools  gladly,  we 
must  fight  the  wilftd  ignorance  of  the  one  and  the 
helpless  ignorance  of  the  other,  not  with  the  sword 
of  righteous  indignation,  but  with  the  skilful  weapon 
of  the  tongue.  On  this  ignorance  the  charlatan 
and  the  quack  live,  and  it  is  by  no  means  an  easy 
matter  to  decide  how  best  to  conduct  a  warfare 
against  these  wily  foes,  the  oldest  and  most  for- 
midable with  whom  we  have  to  deal.  As  the  in- 
comparable Fuller  remarks,  'Well  did  the  poets 


204 


THE    PRACTITIONER 


feign  Aesculapius  and  Circe  brother  and  sister  .  .  . 
for  in  all  times  (in  the  opinion  of  the  multitude) 
witches,  old  women,  and  impostors  have  had  a 
competition  with  doctors.'  Education  of  the  public 
of  a  much  more  systematic  and  active  kind  is 
needed.  "*' 

Apathy  our    By  far  the  most  dangerous  foe  we  have  to  fight  is 
™°**  apathy — indifference  from  whatever  cause,  not  from 

foe.  a  lack  of  knowledge,  but  from  carelessness,  from 

absorption  in  other  pursuits,  from  a  contempt  bred 
of  self-satisfaction.  Fully  twenty-five  per  cent,  of 
the  deaths  in  the  community  are  due  to  this  accursed 
apathy,  fostering  a  human  inefiiciency,  and  going 
far  to  counterbalance  the  extraordinary  achieve- 
ments of  the  past  century.  Why  should  we  take 
pride  in  the  wonderful  railway  system  with  which 
enterprise  and  energy  have  traversed  the  land,  when 
the  supreme  law,  the  public  health,  is  neglected  } 
What  comfort  in  the  thought  of  a  people  enjoying 
great  material  prosperity  when  we  know  that  the 
primary  elements  of  life  (on  which  even  the  old 
Romans  were  our  masters)  are  denied  to  them .' 
What  consolation  does  the  '  little  red  school-house ' 
afford  when  we  knbw  that  a  Lethean  apathy  allows 
toll  to  be  taken  of  every  class,  from  the  little  tots 
to  the  youths  and  maidens  ?  Western  civilization 
has  been  born  of  knowledge,  of  knowledge  won  by 
hard,  honest  sweat  of  body  and  brain,  but  in  many  of 
the  most  important  relations  of  life  we  have  failed  to 
make  that  knowledge  effective.  And,  strange  irony 
of  life,  the  lesson  of  human  efficiency  is  being 


OF    MEDICINE  205 

taught  us  by  one  of  the  little  nations  of  the  earth, 
which  has  so  far  bettered  our  instruction  that  we 
must  again  turn  eastward  for  wisdom.  Perhaps  in 
a  few  years  our  civilization  may  be  put  on  trial, 
and  it  will  not  be  without  benefit  if  it  arouses  the 
individual  from  apathy  and  makes  him  conscious 
of  the  great  truth  that  only  by  earnest  individual 
human  effort  can  knowledge  be  made  effective,  and 
if  it  arouses  communities  from  an  apathy  which 
permits  mediaeval  conditions  to  prevail  without  a 
protest.  '^^ 


Against  our  third  great  foe — vice  in  all  its  forms — we  Vice, 
have  to  wage  an  incessant  warfare,  which  is  not  less 
vigorous  because  of  the  quiet,  silent  kind.  Better  than 
any  one  else  the  physician  can  say  the  word  in  season 
to  the  immoral,  to  the  intemperate,  to  the  unchari- 
table in  word  and  deed.  Personal  impurity  is  the  evil 
against  which  we  can  do  most  good,  particularly  to 
the  young,  by  showing  the  possibility  of  the  pure  life 
and  the  dangers  of  immorality.  Had  I  time,  and 
were  this  the  proper  occasion,  I  would  like  to  rouse 
the  profession  to  a  sense  of  its  responsibility  toward 
the  social  evil — the  black  plague  which  devastates  the 
land.  I  can  but  call  your  attention  to  an  important 
society,  of  which  Dr.  Prince  Morrow  of  New  York 
is  the  organizer,  which  has  for  one  of  its  objects  the 
education  of  the  public  on  this  important  question. 
I  would  urge  you  to  join  in  a  crusade  quite 
as  important  as  that  in  which  we  are  engaged 
against  tuberculosis.  *' 


2o6 


THE    PRACTITIONER 


Humility. 
Confidence. 


Just  pride 
and  hope. 


Mental  in- 
dependence. 


Self- 
satis£action. 


To  each  one  of  you  the  practice  of  medicine  will 
be  very  much  as  you  make  it — to  one  a  worry, 
a  care,  a  perpetual  annoyance ;  to  another,  a  daily 
joy  and  a  life  of  as  much  happiness  and  usefulness 
as  can  well  fall  to  the  lot  of  man,  because  it  is 
a  life  of  self-sacrifice  and  of  countless  opportu- 
nities to  comfort  and  help  the  weak-hearted, 
and  to  raise  up  those  that  fall.  In  the  student 
spirit  you  can  best  fulfil  the  high  mission  of  our 
noble  calling — in  his  humility^  conscious  of  weak- 
ness, while  seeking  strength ;  in  his  confidence^ 
knowing  the  power  while  recognizing  the  limita- 
tions of  his  art ;  in  his  pride  in  the  glorious  heritage 
from  which  the  greatest  gifts  to  man  have  been 
derived ;  and  in  his  sure  and  certain  hope  that 
the  future  holds  for  us  still  richer  blessings  than 
the  past.'*^ 

In  no  single  relation  of  life  does  the  general 
practitioner  show  a  more  illiberal  spirit  than  in  the 
treatment  of  himself.  I  do  not  refer  so  much  to 
careless  habits  of  living,  to  lack  of  routine,  or  to 
failure  to  pay  due  attention  to  the  business  side 
of  the  profession — sins  which  so  easily  beset  him — 
but  I  would  speak  of  his  failure  to  realize,  first,  the 
need  of  a  lifelong  progressive  personal  training; 
and  secondly,  the  danger  lest  in  the  stress  of  practice 
he  sacrifice  the  most  precious  of  all  possessions,  his 
mental  independence.  ^^ 

Self-satisfaction,  a  frame  of  mind  widely  diffused, 
is  manifest  often  in  greatest  intensity  where  it  should 


OF    MEDICINE  207 

be  least  encouraged,  and  in  individuals  and  com- 
munities is  sometimes  so  active  on  such  slender 
grounds  that  the  condition  is  comparable  to  the 
delusions  of  grandeur  in  the  Insane.  ^^ 

There  are  men  who  have  never  had  the  preliminary  Experience, 
education  which  would  enable  them  to  grasp  the 
fundamentals  of  the  science  on  which  medicine  Is 
based.  Othershave  had  poor  teachers,  and  have  never 
received  that  bent  of  mind  which  Is  the  all-important 
factor  in  education  ;  others  again  fall  early  into  the 
error  of  thinking  that  they  know  It  all,  and  bene- 
fiting neither  by  their  mistakes  nor  by  their  successes, 
miss  the  very  essence  of  all  experience,  and  die 
bigger  fools.  If  possible,  than  when  they  started.  "^ 

Experience,  In  the  true  sense  of  the  term,  does 

not   come   to  all   with  years,  or  with   increasing 

opportunities.     Growth  in  the  acquisition  of  facts 

is   not    necessarily  associated   with    development. 

Many  grow  through  life  as  the  crystal,  by  simple 

accretion,  and  at  fifty  possess,  to  vary  the  figure, 

the  unicellular  mental  blastoderm  with  which  they 

started.  ^^  . 

9 

Chauvinism  in  the  unit.  In  the  general  practitioner,  Chauvinism 

Is  of  much  more  interest  and  Importance.     It  Is  "^  ^^ . 

amusing  to  read  and  hear  of  the  passing  of  the 

family  physician.     There  never  was  a  time  in  our 

history  in  which  he  was  so  much  In  evidence.  In 

which  he  was  so  prosperous,  in  which  his  prospects 

were  so  good  or  his  power  in  the  community  so 


2o8  THE    PRACTITIONER 

potent.  The  public  has  even  begun  to  get  senti- 
mental over  him.  He  still  does  the  work ;  the 
consultants  and  the  specialists  do  the  talking-  and 
the  writing-,  and  take  the  fees.  By  the  work,  I  mean 
the  great  mass  of  routine  practice  which  brings  the 
doctor  into  every  household  in  the  land  and  makes 
him,  not  alone  the  adviser,  but  the  valued  friend. 
He  is  the  standard  by  which  we  are  measured. 
What  he  is,  we  are ;  and  the  estimate  of  the  pro- 
fession in  the  eyes  of  the  public  is  their  estimate  of 
him.  A  well-trained,  sensible  doctor  is  one  of  the 
most  valuable  assets  of  a  community,  worth  to-day, 
as  in  Homer's  time,  many  another  man.  To  make 
him  efficient  is  our  highest  ambition  as  teachers,  to 
save  him  from  evil  should  be  our  constant  care  as 
a  guild.  ^^ 

The  general    The  circumstances  of  life  mould  him  (the  family 
practitioner,    physician)    into   a   masterful,    self-confident,    self- 
centred  man,  whose  worst  faults  often  partake  of 
his  best  qualities.  ^^ 

The  isola-  Few  men  live  lives  of  more  devoted  self-sacrifice 
tionofprao  ^j^^j^  ^^g  family  physician,  but  he  may  become  so 
completely  absorbed  in  work  that  leisure  is  un- 
known ;  he  has  scarce  time  to  eat  or  sleep,  and,  as 
Dr.  Drummond  remarks  in  one  of  his  poems,  '  He 
is  the  only  man,  I  know  me,  don't  get  no  holiday.' 
There  is  danger  in  this  treadmill  life  lest  he  lose 
more  than  health  and  time  and  rest — his  intellectual 
independence.  More  than  most  men  he  feels  the 
tragedy  of  isolation — that  inner  isolation  so  well 


OF   MEDICINE  209 

expressed  in  Matthew  Arnold's  line,  *We  mortal 
millions  live  alone.'  ^^ 

Even  in  populous  districts  the  practice  of  medicine  The  lonely 
is  a  lonely  road  which  winds  uphill  all  the  way,  ^°^^' 
and  a  man  may  easily  go  astray  and  never  reach 
the  Delectable  Mountains  unless  he  early  finds  those 
shepherd  guides  of  whom  Bunyan  tells,  Knowledge, 
Experience,  Watchful,  and  Sincere.  ""^ 

At  times,  and  in  degrees  difiering  with  our  tempera- 
ments, there  come  upon  us  bouts  of  depression, 
when  we  feel  that  the  battle  has  been  lost,  and  that 
to  fight  longer  is  not  worth  the  effort,  periods  when, 
amid  the  weariness,  the  fever,  and  the  fret  of  daily 
practice,  things  have  gone  against  us;  we  have 
been  misunderstood  by  patients,  our  motives  have 
been  wrongly  interpreted,  and  smitten  perhaps  in 
the  house  of  our  friends,  the  worries  of  heart,  to 
which  we  doctors  are  so  subject,  make  us  feel 
bitterly  the  uncertainties  of  medicine  as  a  profession, 
and  at  times  make  us  despair  of  its  future.  In 
a  voice  that  one  may  trust,  Bartlett  concludes  his 
inquiry  with  these  memorable  words,  which  I  quote, 
in  the  hope  that  they  may  soothe  the  heartache  of 
any  pessimistic  brother : — 

'There  is  no  process  which  can  reckon  up  the  Words  to 
amount  of  good   which   the   science   and   art   of  soothe  the 
medicine  have  conferred  upon  the  human  race;  ^^^^^^^^^^ 
there  is  no  moral  calculus   that  can   grasp   and 
comprehend  the  simi  of  their  beneficent  operations. 

P 


210  THE   PRACTITIONER 

Ever  since  the  first  dawn  of  civilization  and  learning, 
through 

"  The  dark  backward,  and  abysm  of  time," 

they  have  been  the  true  and  constant  friends  of  the 
suffering  sons  and  daughters  of  men.  Through 
their  ministers  and  disciples,  they  have  cheered  the 
desponding ;  they  have  lightened  the  load  of  human 
sorrow ;  they  have  dispelled  or  diminished  the  gloom 
of  the  sick-chamber ;  they  have  plucked  from  the 
pillow  of  pain  its  thorns,  and  made  the  hard  couch 
soft  with  the  poppies  of  delicious  rest ;  they  have 
let  in  the  light  of  joy  upon  dark  and  desolate 
dwellings ;  they  have  rekindled  the  lamp  of  hope 
in  the  bosom  of  despair ;  they  have  called  back  the 
radiance  of  the  lustreless  eye  and  the  bloom  of 
the  fading  cheek;  they  have  sent  new  vigour  through 
the  failing  limbs ;  and,  finally,  when  exhausted  in 
all  their  other  resources,  and  baffled  in  their  skill — 
handmaids  of  philosophy  and  religion — they  have 
blunted  the  arrows  of  death,  and  rendered  less 
rugged  and  precipitous  the  inevitable  pathway  to 
the  tomb.  In  the  circle  of  human  duties,  I  do  not 
know  of  any,  short  of  heroic  and  perilous  daring, 
or  religious  martyrdom  and  self-sacrifice,  higher 
and  nobler  than  those  of  the  physician.  His  daily 
round  of  labour  is  crowded  with  beneficence,  and 
his  nightly  sleep  is  broken,  that  others  may  have 
better  rest.  His  whole  life  is  a  blessed  ministry  of 
consolation  and  hope.'  ^^ 

Fate.  Alike  in  that  you  are  men,  and  white,  you  are 

unlike  in  your  features,  very  unlike  in  your  minds 
and  in  your  mental  training,  and  your  teachers  will 
mourn  the  singular  inequalities  in  your  capacities. 
And  so  it  is  sad  to  think  will  be  your  careers ;  for 


OF    MEDICINE  211 

one  success,  for  another  failure ;  one  will  tread  the 
primrose  path  to  the  great  bonfire,  another  the 
straight  and  narrow  way  to  renown ;  some  of 
the  best  of  you  will  be  stricken  early  on  the  road, 
and  will  join  that  noble  band  of  youthful  martyrs 
who  loved  not  their  lives  to  the  death ;  others, 
perhaps  the  most  brilliant  among  you,  like  my  old 
friend  and  comrade,  Dick  Zimmerman  (how  he 
would  have  rejoiced  to  see  this  day !),  the  fates  will 
overtake  and  whirl  to  destruction  just  as  success 
seems  assured.  When  the  iniquity  of  oblivion  has 
blindly  scattered  her  poppy  over  us,  some  of  you 
will  be  the  trusted  counsellors  of  this  community, 
and  the  heads  of  departments  of  this  faculty  ;  while 
for  the  large  majority  of  you,  let  us  hope,  is 
reserved  the  happiest  and  most  useful  lot  given  to 
man — to  become  vigorous,  whole-souled,  intelligent, 
general  practitioners.  ^* 

In  a  play  of  Oscar  Wilde's  one  of  the  characters  Success. 
remarks, '  There  are  only  two  great  tragedies  in  life, 
not  getting  what  you  want — and  getting  it ! '  and 
I  have  known  consultants  whose  treadmill  life 
illustrated  the  bitterness  of  this  mot^  and  whose 
great  success  at  sixty  did  not  bring  the  success  they 
had  anticipated  at  forty.  The  mournful  echo  of  the 
words  of  the  preacher  rings  in  their  ears,  words 
which  I  not  long  ago  heard  quoted  with  deep  feel- 
ing by  a  distinguished  physician :  '  Better  is  an 
handful  with  quietness,  than  both  the  hands  full 
with  travail  and  vexation  of  spirit,'  ^ 

P  2 


2T2 


THE   PRACTITIONER 


Thecon- 
stiltant 


The  con- 
sultant's 
second 
period. 


The  con- 
sultant's 


Poll  the  successful  consulting  physicians  of  this 
country  to-day,  and  you  will  find  that  they  have 
evolved  either  from  general  practice  or  from 
laboratory  and  clinical  work;  and  many  of  the 
most  prominent  have  risen  from  the  ranks  of 
general  practitioners.  ^ 

This  is,  of  course,  a  very  full  programme,  but  in 
ten  years  a  bright  man,  with  what  Sydenham  calls 
'  the  ancient  and  serious  diligence  of  Hippocrates,' 
will  pick  up  a  very  fair  education,  and  will  be  fit  to 
pass  from  the  dispensary  to  the  wards.  ^ 

Ten  years'  hard  work  tells  with  colleagues  and 
friends  in  the  profession,  and  with  enlarged  clinical 
faculties  the  physician  enters  upon  the  second,  or 
bread-and-butter  period.  This,  to  most  men,  is  the 
great  trial,  since  the  risks  are  greater,  and  many 
now  drop  out  of  the  race,  wearied  at  the  length 
of  the  way,  and  drift  into  specialism  or  general 
practice.  ^ 

The  physician  develops  more  slowly  than  the 
surgeon,  and  success  comes  later.  There  are 
surgeons  at  forty  years  in  full  practice  and  at  the 
very  top  of  the  wave,  a  time  at  which  the  physician 
is  only  preparing  to  reap  the  harvest  of  years  of 
patient  toil.  The  surgeon  must  have  hands,  and 
better,  young  hands.  ^ 

At  the  end  of  twenty  years,  when  about  forty-five, 
our  Lydgate  should  have  a  first-class  reputation  in 


OF   MEDICINE  213 

the  profession,  and  a  large  circle  of  friends  and  brain  is  his 

students.      He  will  probably  have  precious  little  *^P*^- 

capital  in  the  bank,  but  a  very  large  accumulation 

of  interest-bearing  funds  in  his  brain-pan.     He  has 

gathered  a  stock  of  special  knowledge  which  his 

friends  in  the  profession  appreciate,  and  they  begin 

to  seek  his  counsel  in  doubtful  cases,  and  gradually 

learn  to  lean  upon  him  in  times  of  triaL     He  may 

awake  some  day,  perhaps  quite  suddenly,  to  find 

that  twenty  years  of  quiet  work,  done  for  the  love 

of  it,  has  a  very  solid  value.  ^ 

In  looking  over  my  notes  I  find  certain  cases  in  Thecon- 

which  the  visit  has  been  of  vital  moment  to  the  fultant  and 

the  consulta^ 
patient,  usually  in  making  a  diagnosis,  upon  which  tiou . 

successful    treatment    directly    depended,    as    in 

myxoedema  or    pernicious  anaemia.     In  a  very 

much  larger  number  there  has  been  some  important 

suggestion  to  make,  either  in  prognosis  or  in  the 

management  of  the  case ;  while  in  others  the  chief 

value  of  the  consultation  has  been  in  a  reasonable 

talk  with  the  patient  about   his  condition,  with 

assurance    that    there    was    nothing    serious,  and 

general  advice  as  to  mode  of  life  and  diet.   Coleridge 

somewhere  remarks  that  when  a  man  is  vagfuely  ill 

the  talk  of  a  doctor  about  the  nature  of  his  malady 

tones  him  down  and  consoles.     It  is  very  true,  and 

to  tone  down  and  console  are  important  functions  his  function. 

of  professional  advisers. 

There  is  a  group  of  cases  in  which  the  physician 

seeks  counsel  on  account  of  some  special  obscurity 

in  the  disease,  an  obscurity  which  may  not  be 


214  THE   PRACTITIONER 

lightened  by  the  consultant  after  the  most  careful 
scrutiny.  Not  to  receive  the  positive  information 
they  seek  is  often  a  great  disappointment  to  both 
doctor  and  patient,  but  we  must  remember  that 
there  are — changing  slightly  Sir  Thomas  Browne's 
phraseology — cases  indissoluble  in  physic,  and 
a  diagnosis  is  not  possible  in  every  instance. 
Frankly  to  confess  ignorance  is  often  wiser  than  to 
beat  about  the  bush  with  a  hypothetical  diagnosis. 
Theun-  A  consultant's    life  is   not  without  unpleasant 

pleasant  features,  chief  among  which  is  the  passing  of  judge- 
ment on  the  unhappy  incurables — on  the  cancerous, 
ataxics,  and  paralytics,  who  wander  from  one  city 
to  another.  Few  are  able  to  receive  the  balm  of 
truth,  but  now  and  again  one  meets  with  a  cheery, 
brave  fellow,  who  insists  upon  a  plain,  unvarnished 
statement  of  his  prospects.  Still  more  distressing 
are  the  instances  of  hopeless  illness  in  which,  usually 
for  the  friends'  sake,  the  entire  '  faculty '  is  sum- 
moned. Is  there  anything  more  doleful  than  the 
procession  of  four  or  five  doctors  into  a  sick  man's 
room  ?  Who  does  not  appreciate  Matthew  Arnold's 
wish — 

'  Nor  bring  to  see  me  cease  to  live 

Some  doctor  full  of  phrase  and  fame, 
To  shake  his  sapient  head,  and  give 
The  ill  he  cannot  cure  a  name  '  ? 

How  often  under  such  circumstances  has  the 
bitterness  of  the  last  line  recurred  to  me !  Oliver 
Wendell  Holmes,  in  the  Me'morial  History  of 
Boston^  speaking  of  two  of  the  leading  physicians 
of  the  early  part  of  the  century,  says, '  I  used  often 


OF    MEDICINE  215 

to  hear  him  (Dr.  Danforth)  spoken  of  as  being 
called  in  "  consultation,"  as  the  extreme  unction  of 
the  healing  art  is  called.  If  "  old  Dr.  Danfurt "  or 
"  old  Dr.  JefFers  "  were  seen  entering  a  sick  man's 
door  it  was  very  likely  to  mean  nothing  more  nor 
less  than  a  nunc  dimitiis^  Tis  not  pleasant  to 
think  that  pallida  mors  so  often  treads  upon 
our  heels. 

There  is  nothing  new  under  the  sun,  and  the 
common  practice  of  friends  who,  wishing  to  leave 
nothing  undone,  call  in  a  batch  of  consultants  is 
by  no  means  modern.  In  the  delightful  lectures 
on  Latin  Poetry^  delivered  in  1893  at  the  Johns 
Hopkins  University,  Professor  Tyrrell,  of  Dublin, 
quoted  a  long  passage  from  the  Satyricon  of 
Petronius.  The  friends  were  discussing  poor 
Chrysanthus,  who  had  just  '  slipped  his  wind.' 
Seleucus  says,  '  And  it  is  not  as  if  he  hadn't  tried 
the  fasting  cure.  For  five  days  neither  bit  nor  sup 
passed  his  lips,  and  yet  he's  gone.  Too  many 
doctors  did  for  him,  or  else  it  was  to  be.  A  doctor 's 
reaUy  no  use  except  to  feel  you  did  the  right  thing.' 
The  last  sentence  might  have  come  from  George 
Eliot  or  George  Meredith. 

The  value  of  careful  note-taking  is  recognized  by  Note-taking 

most  consultants.    I  know,  however,  several  men  in  fi° 

' .  '  time  re- 

large  practice  who  have  discarded  it  as  altogether  quired. 

too  onerous,  and  as  taking  up  much  more  time  than 

it  is  worth.    The  material  which  an  active  consultant 

may  collect  in  a  long  life  is  enormous.     The  late 

Austin  Flint's  notes  cover  16,922  folio  pages,  all 

written  with  his  own  hand.  The  late  Palmer  Howard 


2l6  THE   PRACTITIONER 

constandy  lamented  that  the  leisure  never  came  in 
which  he  could  work  over  the  clinical  records 
which  he  had  so  faithfully  kept  for  so  many 
years. 

A  case  cannot  be  satisfactorily  examined  in  less 
than  half  an  hour,  unless  the  notes  have  been  taken 
previously  by  an  assistant,  a  plan  which  consultants 
in  very  large  practice  might  adopt  more  widely. 
A  sick  man  likes  to  have  plenty  of  time  spent  over 
him,  and  he  gets  no  satisfaction  in  a  hurried  ten  or 
twelve  minutes'  examination.  If  one  never  saw  a 
patient  the  second  time,  notes  might  be  superfluous, 
but  can  anything  be  more  embarrassing  in  a  return 
visit  than  to  have  forgotten  name,  face,  malady, 
everything  ?  At  such  a  moment  well- indexed  notes 
are  worth  their  weight  in  gold.  Last  year  I  had 
a  notable  illustration  of  the  value  of  memoranda, 
however  slight.  Dr.  Bray,  of  Chatham,  brought 
a  patient,  whom  from  certain  peculiarities  I  remem- 
bered at  once,  though  nearly  twelve  years  had 
elapsed  since  I  had  seen  him.  In  1883  he  had,  at 
Dr.  Bray's  suggestion,  consulted  me  in  Montreal. 
Fortunately  I  was  able  to  lay  my  hands  at  once  on 
the  notes  of  the  case.  The  point  of  interest  in  1883 
was  whether  the  impotence  was  an  early  tabetic 
symptom,  an  opinion  favoured  by  Dr.  Jewell,  of 
Chicago,  and  by  a  New  York  specialist  whose  name 
I  do  not  remember.  In  the  twelve  years  the  patient's 
condition  had  remained  unchanged,  and  many  of 
the  symptoms  which  he  thought  were  of  recent 
origin  had  been  present  at  his  first  visit.  Neither 
the  patient  nor  Dr.  Bray  had  any  recollection  of 


OF   MEDICINE  217 

a  previous  consultation  with,  me,  of  the  truth  of 
which  only  my  notes  convinced  them. 

The  histories  may  be  taken  very  conveniently  on 
the  cards  of  the  Boston  Library  Bureau,  and  filed 
away  alphabetically.  I  have  had  much  comfort 
since  the  adoption  of  this  plan.  It  is  a  great  saving 
of  time  and  labour  to  dictate  the  condition  of  the 
patient  to  a  secretary,  who  can  (if  the  arrangement 
of  the  consulting-rooms  is  not  convenient)  be 
secluded  behind  a  screen.  She  can  afterwards  add 
the  notes  to  the  card  on  which  the  history  has  been 
taken. 

For  several  years  I  have  adopted  the  plan  of 
dictating  at  odd  times  abstracts  of  the  histories  of 
special  cases  and  filing  them  in  order  ready  for 
publication.  In  this  way,  when  noting  carefully 
during  the  session  of  1892-3  all  the  cases  of 
abdominal  timiour  which  came  before  me  for  dia- 
gnosis, I  had,  in  October,  1893,  when  I  began  the 
series  of  lectures  which  have  been  published,  all 
the  cases  type-written  and  ready.     It  has  always  Value  of 

been  a  regret  to  me  that  I  had  not  learned  steno-  ^*®°?" 

°  .  graphy. 

graphy,  which  Sir  William  Gowers  has  found  so 

serviceable,  and  the  use  of  which  in  medical  work 

he  has  advocated  so  warmly.  '^^ 

The  environment  of  a  large  city  is  not  essential  to  The  con- 
the  growth  of  a  good  clinical  physician.     Even  in  stiltaiit  m 
small  towns  a  man  can,  if  he  has  it  in  him,  become  towns, 
well  versed  in  methods  of  work,  and  with  the  assist- 
ance of  an  occasional  visit  to  some  medical  centre 
he  can  become  an  expert  diagnostician  and  reach 


2l8     THE    PRACTITIONER   OF   MEDICINE 

a  position  of  dignity  and  worth  in  the  community 
in  which  he  lives.  ^ 

I  wish  to  plead  particularly  for  the  wasted 
opportunities  in  the  smaller  hospitals  of  our  large 
cities,  and  in  those  of  more  moderate  size.  There 
are  in  this  State  a  score  or  more  of  hospitals  with 
from  thirty  to  fifty  medical  beds,  offering  splendid 
material  for  good  men  on  which  to  build  reputa- 
tions. ^ 


CUPID  AND  MARRIAGE 


*A  young  man  married  is  a  man  that 's  marred.' 

(Shakespeare.) 

'  Nought  beneath  the  sky 
More  sweet,  more  worthy  is  than  firm  consent 
Of  man  and  wife  in  household  government' 

(Odyssey t  Chapman's  translation.) 


220 


CUPID   AND 


Hopeless 
passion. 


Marriage.  So  truly  as  a  young  man  married  is  a  young  man 
marred  is  a  woman  unmarried,  in  a  certain  sense, 
a  woman  undone.  ^^ 

lb  the  worries  of  uncertain  health  and  greatly 
embarrassed  affairs  there  were  added,  in  the  summer 
of  1810,  the  pangs,  one  can  hardly  say  of  disprized, 
but  certainly  of  hopeless  love.  Writing  to  his 
friend  Reynolds,  March  3,  181 8,  in  comparing  life 
to  a  large  mansion  of  many  apartments,  Keats  says 
pathetically  that  he  could  only  describe  two ;  the 
first,  the  Infant  or  Thoughtless  Chamber,  in  which 
we  remain  as  long  as  we  do  not  think  ;  and  the 
second,  the  Chamber  of  Maiden-Thought,  in  which 
we  first  become  intoxicated  with  the  light  and 
atmosphere,  until  it  gradually  darkens  and  we  see 
not  well  the  exit  and  we  feel  the  '  burden  of  the 
mystery.'  For  his  friends  he  hopes  the  third 
Chamber  of  Life  may  be  filled  with  the  wine  of 
love  and  the  bread  of  friendship.  Poor  fellow! 
Within  a  year  the  younger  Aphrodite,  in  the  shape 
of  Fanny  Brawne,  beckoned  to  him  from  the  door 
of  the  third  chamber.  Through  her  came  no 
peace  to  his  soul,  and  the  Muses'  inspiration  was 
displaced  by  a  passion  which  rocked  him  as  the 
*  winds  rock  the  ravens  on  high ' — by  Plato's  fourth 
variety  of  madness,  which  brought  him  sorrow  and 
'  leaden-eyed  Despair.'  ^^ 

Emotions  on  How  shall  he  (the  young  physician)   live  mean- 

^^^  while  ?     On  crumbs — on  pickings   obtained  from 

men  in  the  cakes-and-ale  stage  (who  always  can 


MARRIAGE  221 

put  paying  work  into  the  hands  of  the  young  men), 
and  on  fees  from  some  classes,  journal  work,  private 
instruction,  and  from  work  in  the  schools.  Any 
sort  of  medical  practice  should  be  taken,  but  with 
caution — too  much  of  it  early  may  prove  a  good 
man's  ruin.  He  cannot  expect  to  do  more  than  just 
eke  out  a  living.  He  must  put  his  emotions  on 
ice  ;  there  must  be  no  '  Amaryllis  in  the  shade,'  and 
he  must  beware  the  tangles  of '  Neaera's  hair.'  ^ 

Another  potent  cause  of  worry  is  an  idolatry  by  The  two 
which  many  of  you  will  be  sore  let  and  hindered,  goddesses. 
The  mistress  of  your  studies  should  be  the  heavenly 
Aphrodite,  the  motherless  daughter  of  Uranus. 
Give  her  your  whole  heart,  and  she  will  be  your 
protectress  and  friend.  A  jealous  creature,  brook- 
ing no  second,  if  she  finds  you  trifling  and  coquet- 
ting with  her  rival,  the  younger,  earthly  Aphrodite, 
daughter  of  Zeus  and  Dione,  she  will  whistle  you 
off  and  let  you  down  the  wind  to  be  a  prey,  perhaps 
to  the  examiners,  certainly  to  the  worm  Regret.  In 
plainer  language,  put  your  affections  in  cold  storage 
for  a  few  years,  and  you  will  take  them  out  ripened, 
perhaps  a  little  mellow,  but  certainly  less  subject  to 
those  frequent  changes  which  perplex  so  many 
young  men.  Only  a  grand  passion,  an  all-absorb- 
ing devotion  to  the  elder  goddess,  can  save  the 
man  with  a  congenital  tendency  to  philandering, 
the  flighty  Lydgate  who  sports  with  Celia  and 
Dorothea,  and  upon  whom  the  judgement  ulti- 
mately falls  in  a  basil-plant  of  a  wife  like 
Rosamond.  ^* 


WORK 

THE  MASTER-WORD 

It  seems  a  bounden  duty  on  such  an  occasion  to  be  honest 
and  frank,  so  I  propose  to  tell  you  the  secret  of  life  as 
I  have  seen  the  game  played,  and  as  I  have  tried  to  play 
it  myself.  You  remember  in  one  of  the  Jungle  Stories  that 
when  Mowgli  wished  to  be  avenged  on  the  villagers  he 
could  only  get  the  help  of  Hathi  and  his  sons  by  sending 
them  the  master-word.  This  I  propose  to  give  you  in  the 
hope,  yes,  in  the  full  assurance,  that  some  of  you  at  least 
will  lay  hold  upon  it  to  your  profit.  Though  a  little  one, 
the  master-word  looms  large  in  meaning.  It  is  the  *  Open„ 
Sesame '  to  every  portal,  the  great  equalizer  in  the  world, 
the  true  philosopher's  stone  which  transmutes  all  the  base 
metal  of  humanity  into  gold.  The  stupid  man  among  you 
it  will  make  bright,  the  bright  man  brilliant,  and  the 
brilliant  student  steady.  With  the  magic  word  in  your  heart 
all  things  are  possible,  and  without  it  all  study  is  vanity 
and  vexation.  The  miracles  of  life  are  with  it ;  the  blind 
see  by  touch,  the  deaf  hear  with  eyes,  the  dumb  speak  with 
fingers.  To  the  youth  it  brings  hope,  to  the  middle-aged 
confidence,  to  the  aged  repose.  True  balm  of  hurt  minds, 
in  its  presence  the  heart  of  the  sorrowful  is  lightened  and 
consoled.  It  is  directly  responsible  for  all  advances  in 
medicine  dtuing  the  past  twenty-five  centuries.  Lajmig 
hold  upon  it  Hippocrates  made  observation  and  science  the 
warp  and  woof  of  our  art.  Galen  so  read  its  meaning  that 
fifteen  centuries  stopped  thinking,  and  slept  until  awakened 
by  the  De  Fabrics  of  Vesalius,  which  is  the  very  incarnation 
of  the  master. word.  With  its  inspiration  Harvey  gave  an 
impulse  to  a  larger  circulation  than  he  wot  of,  an  impulse 
which  we  feel  to-day.  Hunter  sounded  all  its  heights  and 
depths,  and  stands  out  in  our  history  as  one  of  the  great 
exemplars  of  its  virtue.  With  it  Virchow  smote  the  rock, 
and  the  waters  of  progress  gushed  out ;  while  in  the  hands 
of  Pasteur  it  proved  a  very  talisman  to  open  to  us  a  new 
heaven  in  medicine  and  a  new  earth  in  surgery.  Not  only 
has  it  been  the  touchstone  of  progress,  but  it  is  the  measure 
of  success  in  everyday  life.  Not  a  man  before  you  but  is 
beholden  to  it  for  his  position  here,  while  he  who  addresses 
you  has  the  honour  directly  in  consequence  of  having  had 
it  graven  on  his  heart  when  he  was  as  you  are  to-day. 
And  the  master-word  is  WORK.  ^* 


224  WORK 

A  relish  for    I  was  much  interested  the  other  day  in  reading 
work.  ^  letter  of  John  Locke  to  the  Earl  of  Peterborough, 

who  had  consulted  him  about  the  education  of  his 
son.  Locke  insisted  that  the  main  point  in  educa- 
^tion  is  to  get  '  a  relish  of  knowledge.  This  is 
putting  life  into  a  pupil.'  Get  early  this  relish, 
this  clear,  keen  enjoyance  in  work,  with  which 
languor  disappears  and  all  shadows  of  annoyance 
flee  away.  '^ 

Haste.  Fevered  haste  is  not  encouraged  in  military  circles, 

and  if  you  can  adapt  your  intellectual  progress 
to  army  rules,  making  each  step  in  your  mental 
promotion  the  lawful  successor  of  some  other,  you 
wiU  acquire  little  by  little  those  staying  powers 
without  which  no  man  is  of  much  value  in  the 
ranks.  ^^ 

Ohae  Hast,  Success  during  the  first  ten  years  means  endurance 
obae  Rast.  ^^^^  perseverance  ;  all  things  come  to  him  who  has 
learned  to  labour  and  to  wait,  who  bides  his  time 
oAne  Hasi^  aber  ohne  Rast^  whose  talent  develops 
in  der  Stille^  in  the  quiet  fruitful  years  of  unselfish 
work.  ^ 

Live  for  tbe    As  to  the  method  of  work,  I  have  a  single  bit 
^y*  of  advice,  which  I  give  with  the  earnest  conviction 

of  its  paramount  influence  in  any  success  which 
may  have  attended  my  efforts  in  life — Take  no 
thought  for  the  morrow.  Live  neither  in  the 
past  nor  in  the  future,  but  let  each  day's  work 


WORK  225 

absorb  your  entire  energies,  and  satisfy  your  widest 
ambition.  '^ 

The  student  who  is  worrying  about  his  future, 
anxious  over  the  examinations,  doubting  his  fitness 
for  the  profession,  is  certain  not  to  do  so  well  as 
the  man  who  cares  for  nothing  but  the  matter  in 
hand,  and  who  knows  not  whither  he  is  going.  ^^ 

Throw  away,  in  the  first  place,  all  ambition  beyond  The  day's 
that  of  doing  the  day's  work  well.  '^  ^""^* 

The  travellers  on  the  road  to  success  live  in  the 
present,  heedless  of  taking  thought  for  the  morrow, 
having  been  able  at  some  time,  and  in  some  form  or 
other,  to  receive  into  their  heart  of  hearts  this 
maxim  of  the  Sage  of  Chelsea:  Your  business 
is  '  not  to  see  what  lies  dimly  at  a  distance,  but  to 
do  what  lies  clearly  at  hand.'  ^"^ 

Another  aspect  of  the  life  of  the  army  surgeon,  Isolation, 
isolation  in  some  degree  from  professional  col- 
leagues, will  influence  you  in  different  ways — 
hurtfully  in  the  more  dependent  natures,  helpfully 
in  those  who  have  learned  that  '  not  from  without 
us,  only  from  within,  comes,  or  can  ever  come, 
upon  us  light' — and  to  such  the  early  years  of 
separation  from  medical  societies  and  gatherings 
will  prove  a  useful  seed-time  for  habits  of  study, 
and  for  the  cultivation  of  the  self-reliance  that 
forms  so  important  an  element  in  the  outfit  of 
the  practitioner.^^ 

Q 


226  WORK 

In  the  history  of  the  profession  there  are  grounds 
for  the  statement  that  isolation  promoted  originality. 
Some  of  the  most  brilliant  work  has  been  done  by 
men  in  extremely  limited  spheres  of  action,  and 
during  the  past  hundred  years  it  is  surprising  how 
many  of  the  notable  achievements  have  been  made 
by  physicians  dwelling  far  from  educational  cen- 
tres. Jenner  worked  out  his  discovery  in  a  village ; 
McDowell,  Long,  and  Sims  were  country  doctors ; 
Koch  was  a  district  physician.  ^^ 

Industry        He  (Bassett)  was  very  much  impressed  by  the  inces- 
e^ential  at    g^jj|.  industry  of  the  French  physicians.     He  says : — 

*When  I  look  at  some  of  the  medical  men 
by  whom  I  am  surrounded,  it  makes  me  blush  for 
shame  ;  old  men  daily  may  be  seen  mixing  their 
white  locks  with  boys,  and  pursuing  their  profession 
with  the  ardour  of  youth.  There  is  not  a  solitary 
great  man  in  France  that  is  idle,  for  if  he  were,  that 
moment  he  would  be  outstripped  ;  it  is  a  race,  and 
there  are  none  so  far  ahead  that  they  are  not  pressed 
by  others ;  many  are  distanced,  it  is  true,  but  there 
are  none  allowed  to  walk  over  the  course.  Witness 
Broussais,  lecturing  and  labouring  daily  to  sustain 
himself,  after  having  elevated  himself  to  the  pin- 
nacle; Lisfranc,  an  old  bachelor  with  thousands, 
who  after  having  made  his  daily  visit  and  /epou 
for  ten  months  for  duty,  during  the  vacation  of  two 
months  he  from  choice  gives  a  course  of  operations ; 
and  old  Rollier  may  be  seen  daily  supporting  him- 
self from  bedpost  to  bedpost  as  jolly  as  if  he  were 
not  far  over  sixty.  Velpeau  from  a  poor  boy 
without  money,  time,  education,  or  friends  has 
by  industry  made  himself  one  of  the  first  surgeons 
in  Europe.' " 


WORK  227 

A  few  words  in  addition  about  this  dry-bread  Out-patient 

decade.     He  should  stick  closely  to  the  dispen-  department; 

J.    ^         t  .  ,      1     M  .     work  in. 

sanes.     A  first-class  reputation  may  be  built  up  in 

them.  Byrom  Bramwell's  Atlas  of  Medicine 
largely  represents  his  work  while  an  assistant  phy- 
sician to  the  Royal  Infirmary,  Edinburgh.  Many 
of  the  best-known  men  in  London  serve  ten, 
fifteen,  or  even  twenty  years  in  the  out-patient 
departments  before  getting  wards.  Lauder  Brun- 
ton  only  obtained  his  full  physicianship  at  St. 
Bartholomew's  after  a  service  of  more  than  twenty 
years  in  the  out-patient  department.^ 

Faithfulness  in  the  day  of  small  things  will  insensi-  The  small 
bly  widen  your  powers,  correct  your  faculties ;  and,  ^^^ 
in  moments  of  despondency,  comfort  may  be  de- 
rived from  a  knowledge  that  some  of  the  best  work 
of  the  profession  has  come  from  men  whose  cUnical 
field  was  limited  but  well  tilled.  ^ 

The  important  thing  is  to  make  the  lesson  o£ 
each  case  tell  on  your  education.  The  value  of  ex- 
perience is  not  in  seeing  much,  but  in  seeing 
wisely.  "*^ 

How  can  you  take  the  greatest  possible  advantage  System, 
with  the  least  possible  strain  ?  By  cultivating 
system.  I  say  cultivating  advisedly,  since  some 
of  you  will  find  the  acquisition  of  systematic  habits 
very  hard.  There  are  minds  congenitally  sys- 
tematic ;  others  have  a  lifelong  fight  against  an 
inherited  tendency  to  dijBFuseness  and  carelessness 
Q2 


228  WORK 

in  work.  A  few  brilliant  fellows  have  to  dispense 
with  it  altogether,  but  they  are  a  burden  to  their 
brethren  and  a  sore  trial  to  their  intimates.  I  have 
heard  it  remarked  that  order  is  the  badge  of  an 
ordinary  mind.  So  it  may  be,  but  as  practitioners 
of  medicine  we  have  to  be  thankful  to  get  into  that 
useful  class.  Let  me  entreat  those  of  you  who  are 
here  for  the  first  time  to  lay  to  heart  what  I  say  on 
this  matter.  Forget  all  else,  but  take  away  this 
counsel  of  a  man  who  has  had  to  fight  a  hard  battle, 
and  not  always  a  successful  one,  for  the  little  order 
he  has  had  in  his  life  ;  take  away  with  you  a  pro- 
found conviction  of  the  value  of  system  in  your 
work.  I  appeal  to  the  freshmen  especially,  because 
you  to-day  make  a  beginning,  and  your  future 
career  depends  very  much  upon  the  habits  you  will 
form  during  this  session.  To  follow  the  routine 
of  the  classes  is  easy  enough,  but  to  take  routine 
into  every  part  of  your  daily  life  is  a  hard  task. 
Some  of  you  will  start  out  joyfully  as  did  Christian 
and  Hopeful,  and  for  many  days  will  journey  safely 
towards  the  Delectable  Mountains,  dreaming  of 
them,  and  not  thinking  of  disaster  until  you  find 
yourselves  in  the  strong  captivity  of  Doubt  and 
under  the  grinding  tyranny  of  Despair.  You  have 
been  over-confident.  Begin  again  more  cautiously. 
No  student  escapes  wholly  from  these  perils  and 
trials  ;  be  not  disheartened,  accept  them.  Let  each 
hour  of  the  day  have  its  allotted  duty,  and  cultivate 
that  power  of  concentration  which  grows  with  its 
exercise,  so  that  the  attention  neither  flags  nor 
wavers,  but  settles  with  a  bull-dog  tenacity  on 


WORK  229 

the  subject  before  you.  Constant  repetition  makes 
a  good  habit  fit  easily  in  your  mind,  and  by  the 
end  of  the  session  you  may  have  gained  that  most 
precious  of  knowledge — the  power  to  work.  Do 
not  under-estimate  the  difficulty  you  will  have 
in  wringing  from  your  reluctant  selves  the  stern 
determination  to  exact  the  uttermost  minute  on 
your  schedule.  Do  not  get  too  interested  in  one 
study  at  the  expense  of  another,  but  so  map  out 
your  day  that  due  allowance  is  given  to  each. 
Only  in  this  way  can  the  average  student  get  the 
best  that  he  can  out  of  his  capacities.  And  it  is 
worth  all  the  pains  and  trouble  he  can  possibly 
take  for  the  ultimate  gain,  if  he  can  reach  his 
doctorate  with  system  so  ingrained  that  it  has 
become  an  integral  part  of  his  being.  ^'* 

Ask  of  any  active  business  man  or  a  leader  in 
a  profession  the  secret  which  enables  him  to  accom- 
plish much  work,  and  he  will  reply  in  one  word, 
system  ;  or  as  I  shall  term  it,  the  virtue  of  ■method^ 
the  harness  without  which  only  the  horses  of  genius 

travel.  ^^  , 

9 

There  are  two  aspects  of  this  subject ;  the  first 
relates  to  the  orderly  arrangement  of  your  work, 
which  is  to  some  extent  enforced  by  the  roster 
of  demonstrations  and  lectures,  but  this  you  will  do 
well  to  supplement  in  private  study  by  a  schedule 
in  which  each  hour  finds  its  allotted  duty.  ^^ 

Thus  faithfully  followed  day  by  day,  system  may 
become  at  last  engrained   in    the  most  shiftless 


230  WORK 

nature,  and  at  the  end  of  a  semester  a  youth  of 
moderate  ability  may  find  himself  far  in  advance 
of  the  student  who  works  spasmodically,  and  trusts 
to  cramming.  ^^ 

The  incessant  and  irregular  demands  upon  a 
busy  doctor  make  it  (system)  very  difficult  to 
retain,  but  the  public  in  this  matter  can  be  educated, 
and  the  men  who  practise  with  system,  allotting 
a  definite  time  of  the  day  to  certain  work,  accom- 
plish much  more  and  have  at  any  rate  a  litde 
leisure ;  while  those  who  are  unmethodical  never 
catch  up  with  the  day's  duties  and  worry  themselves, 
their  confreres^  and  their  patients.  ^^ 

The  secret  of  successful  working  lies  in  the 
systematic  arrangement  of  what  you  have  to  do, 
and  in  the  methodical  performance  of  it.  With 
all  of  you  this  is  possible,  for  few  disturbing  ele- 
ments exist  in  the  student's  life  to  interrupt  the 
allotted  duty  which  each  hour  of  the  day  should 
possess.  Make  out,  each  one  for  himself,  a  time- 
table, with  the  hours  of  lecture,  study,  and  re- 
creation, and  follow  closely  and  conscientiously  the 
programme  there  indicated.  I  know  of  no  better 
way  to  accomplish  a  large  amount  of  work,  and 
it  saves  the  mental  worry  and  anxiety  which  will 
surely  haunt  you  if  your  tasks  are  done  in  an 
irregular  and  desultory  way.  With  too  many, 
unfortunately,  working  habits  are  not  cultivated 
until  the  constraining  dread  of  an  approaching 
examination   is  felt,  when  the  hopeless  attempt 


WORK  231 

is  made  to  cram  the  work  of  two  years  into  a  six 
months'  session  with  results  only  too  evident  to 
your  examiners.  ^' 

With  Laurence   Sterne,  we    can    afford  to  pity  Routine; 
such,  since  they  know  not  that  the  barrenness  of  ^^s  value. 
which  they  complain  is  within  themselves,  a  result 
of  a  lack  of  appreciation  of  the  meaning  and  method 
of  work.  ^^ 

Let  nothing  slip  by  you  ;  the  ordinary  humdrum 
cases  of  the  morning  routine  have  been  accurately 
described  and  pictured,  but  study  each  one  sepa- 
rately as  though  it  were  new — so  it  is,  so  far  as 
your  special  experience  goes ;  and  if  the  spirit 
of  the  student  is  in  you  the  lesson  will  be  there.  ^^ 

Look  at  the  cases  not  from  the  standpoint  of 
textbooks  and  monographs,  but  as  so  many  stepping- 
stones  in  the  progress  of  your  individual  develop- 
ment in  the  art.  This  will  save  you  from  the 
pitiable  mental  attitude  of  the  men  who  travel  from 
Dan  to  Beer-sheba,  and  at  every  step  cry  out  upon 
its  desolation,  its  dreariness,  and  its  monotony.  '^ 

Has  work  no  dangers  connected  with  it?     What  Dangers  of 
of  this  bogie  of  overwork  of  which  we  hear  so  ^^'"''^ 
much  ?     There  are  dangers,  but  they  may  readily 
be  avoided  with  a  little  care.     I  can  only  mention 
two,  one  physical,   one  mental.     The  very  best 
students  are  often  not  the  strongest.     Ill- health,  the 


232  WORK 

bridle  of  Theages,  as  Plato  called  it  in  the  case  of 
one  of  his  friends  whose  mind  had  thriven  at  the 
expense  of  his  body,  may  have  been  the  diverting 
influence  towards  books  or  the  profession.  Among 
the  good  men  who  have  studied  with  me  there 
stands  out  in  my  remembrance  many  a  young 
Lycidas, '  dead  ere  his  prime,'  sacrificed  to  careless- 
ness in  habits  of  living  and  neglect  of  ordinary 
sanitary  laws.  Medical  students  are  much  exposed 
to  infection  of  all  sorts,  to  combat  which  the  body 
must  be  kept  in  first-class  condition.  Grossteste, 
the  great  Bishop  of  Lincoln,  remarked  that  there 
were  three  things  necessary  for  temporal  salvation 
— food,  sleep,  and  a  cheerful  disposition.  Add  to 
these  suitable  exercise  and  you  have  the  means  by 
which  good  health  may  be  maintained.  Not  that 
health  is  to  be  a  matter  of  perpetual  solicitation, 
but  habits  which  favour  the  corpus  sanum  foster 
the  fnens  sana^  in  which  the  joy  of  living  and  the 
joy  of  working  are  blended  in  one  harmony.  Let 
me  read  you  a  quotation  from  old  Burton,  the  great 
authority  on  morbi  erMditorum. : — 

'  There  are  many  reasons  why  students  dote  more 
often  than  others.  The  first  is  their  negligence; 
other  men  look  to  their  tools ;  a  painter  will  wash 
his  pencils ;  a  smith  will  look  to  his  hammer,  anvil, 
forge;  a  husbandman  will  mend  his  plough-irons, 
and  grind  his  hatchet  if  it  be  dull ;  a  falconer  or 
huntsman  wiU  have  an  especial  care  of  his  hawks, 
hounds,  horses,  dogs,  &c. ;  a  musician  will  string 
and  unstring  his  lute,  &c. ;  only  scholars  neglect 
that  instrument,  their  brain  and  spirits  (I  mean), 
which  they  daily  use.  ^* 


WORK  233 

Much  study  is  not  only  believed  to  be  a  weariness  Worry. 
of  the  flesh,  but  also  an  active  cause  of  ill-health  of 
mind,  in  all  grades  and  phases.  I  deny  that  work, 
legitimate  work,  has  anything  to  do  with  this.  It 
is  that  foul  fiend  Worry  who  is  responsible  for  the 
majority  of  the  cases.  The  more  carefully  one 
looks  into  the  cause  of  the  nervous  breakdown  in 
students,  the  less  important  is  work  per  se  as 
a  factor.  There  are  a  few  cases  of  genuine 
overwork,  but  they  are  not  common.  Of  the 
causes  of  worry  in  the  student  life  there  are  three 
of  prime  importance  to  which  I  may  briefly 
refer. 

An  anticipatory  attitude  of  mind,  a  perpetual 
forecasting,  disturbs  the  even  tenor  of  his  way  and 
leads  to  disaster.  Years  ago  a  sentence  in  one  of 
Carlyle's  essays  made  a  lasting  impression  on  me: 
'  Our  duty  is  not  to  see  what  lies  dimly  at  a  distance, 
but  to  do  v»rhat  lies  clearly  at  hand.'  I  have  long 
maintained  that  the  best  motto  for  a  student  is, 
'  Take  no  thought  for  the  morrow.'  Let  the  day's 
work  suJffice;  live  for  it,  regardless  of  what  the  future 
has  in  store,  believing  that  to-morrow  should  take 
thought  for  the  things  of  itself.  There  is  no  such 
safeguard  against  the  morbid  apprehensions  about 
the  future,  the  dread  of  examinations  and  the  doubt 
of  ultimate  success.  Nor  is  there  any  risk  that  such 
an  attitude  may  breed  carelessness.  On  the  contrary, 
the  absorption  in  the  duty  of  the  hour  is  in  itself 
the  best  guarantee  of  ultimate  success.  *  He  that 
observeth  the  wind  shall  not  sow ;  and  he  that 
regardeth  the  clouds  shall  not  reap,'  which  means 


234  WORK 

that  you  cannot  work  profitably  with  your  mind 
set  upon  the  future.  ^'^ 

Banish  the  future ;  live  only  for  the  hour  and  its 
allotted  work.  Think  not  of  the  amount  to  be 
accomplished,  the  difficulties  to  be  overcome,  or 
the  end  to  be  attained,  but  set  earnestly  at  the  little 
task  at  your  elbow,  letting  that  be  sufficient  for 
the  day ;  for  surely  our  plain  duty  is, '  Not  to  see 
what  lies  dimly  at  a  distance,  but  to  do  what  lies 
clearly  at  hand '  (Carlyle).  ^' 

Nemesis  in  In  the  worry  and  strain  of  modern  life,  arterial 
the  strenu-  degeneration  is  not  only  very  common,  but  occurs 
often  at  a  relatively  early  age.  For  this  the  high 
pressure  at  which  men  live,  and  the  habit  of 
working  the  machine  to  its  maximum  capacity,  are 
responsible,  rather  than  excesses  in  eating  and 
drinking,  or  than  any  special  prevalence  of  syphilis. 
Angio-sclerosis,  creeping  on  slowly  but  surely, 
'  with  no  pace  perceived,' '  is  the  Nemesis  through 
which  Nature  exacts  retributive  justice  for  the  trans- 
gression of  her  laws — coming  to  one  as  an  apoplexy, 
to  another  as  an  early  Bright's  disease,  to  a  third 
as  an  aneurism,  and  to  a  fourth  as  angina  pectoris ; 
too  often  slitting  'the  thin -spun  life'  in  the  fifth 
decade  at  the  very  time  when  success  seems  assured. 
Nowhere  do  we  see  such  an  element  of  tragic 
sadness  as  in  many  of  these  cases.  A  man  who 
has  early  risen  and  late  taken  rest,  who  has  eaten 
the  bread  of  carefulness,  striving  for  success  in 
commercial,  professional,    or    political    Hfe,   after 


WORK  235 

twenty-five  or  thirty  years  of  incessant  toil  reaches 
the  point  where  he  can  say,  perhaps  with  just 
satisfaction,  '  Soul,  thou  hast  much  goods  laid  up 
for  many  years,  take  thine  ease,'  all-unconscious 
that  the  fell  sergeant  has  already  issued  the  warrant. 
How  true  to  life  is  Hawthorne  in  The  House  of  the 
Seven  Gables !  To  Judge  Pyncheon,  who  had  ex- 
perienced a  mere  dimness  of  sight  and  a  throbbing 
at  the  heart — nothing  more — and  in  whose  grasp 
was  the  meed  for  which  he  had  '  fought,  and  toiled, 
and  climbed,  and  crept ' ; — to  him,  as  he  sat  in  the 
old  oaken  chair  of  his  grandfathers,  thinking  of 
the  crowning  success  of  his  life,  so  near  at  hand,  the 
avenger  came  through  the  arteries.  ^^ 

While  medicine  is  to  be  your  vocation  or  calling,  Need  of  an 
see  to  it  that  you  have  also  an  avocation — some  avocation, 
intellectual  pastime  which  may  serve  to  keep  you 
in  touch  with  the  world  of  art,  of  science,  or  of 
letters.  Begin  at  once  the  cultivation  of  some 
interest  other  than  the  purely  professional.  The 
difficulty  is  in  a  selection,  and  the  choice  will  be 
different  according  to  your  tastes  and  training.  No 
matter  what  it  is,  have  an  outside  hobby.  For  the 
hard-working  medical  student  it  is  easier  perhaps 
to  keep  up  an  interest  in  literature.  Let  each 
subject  in  your  year's  work  have  a  corresponding 
outside  author.  When  tired  of  anatomy  refresh 
your  minds  with  Oliver  Wendell  Holmes;  after 
a  worrying  subject  in  physiology,  turn  to  the  great 
idealists,  to  Shelley  or  to  Keats,  for  consolation ; 
when  chemistry  distresses  your  soul,  seek  peace  in 


236 


WORK 


the  great  pacifier,  Shakespeare ;  ten  minutes  with 
Montaigne  will  lighten  the  burden.  '^ 


The  man, 
not  the 
doctor. 


Idleness. 


But  do  not  get  too  deeply  absorbed  to  the  exclusion 
of  all  outside  interests.  Success  in  life  depends  as 
much  upon  the  man  as  upon  the  physician.  Mix 
with  your  fellow  students,  mingle  with  their  sports 
and  their  pleasures.  You  are  to  be  members  of 
a  polite  as  well  as  of  a  liberal  profession,  and  the 
more  you  see  of  life  outside  the  narrow  circle  of 
your  work  the  better  equipped  will  you  be  for  the 
struggle.  I  often  wish  that  the  citizens  in  our  large 
educational  centres  would  take  a  little  more  Interest 
in  the  social  life  of  the  students,  many  of  whom 
catch  but  few  glimpses  of  home  life  during  their 
course.  ^^ 

By  nature  man  is  the  incarnation  of  Idleness,  which 
quality  alone,  amid  the  ruined  remnants  of  Edenic 
characters,  remains  in  all  its  primitive  intensity." 


The  philo- 
sophy of 
life. 


For  better  or  worse,  there  are  few  occupations  of 
a  more  satisfying  character  than  the  practice  of 
medicine,  if  a  man  can  but  once  get  orientirt  and 
bring  to  it  the  philosophy  of  honest  work,  the 
philosophy  that  insists  that  we  are  here,  not  to  get 
all  we  can  out  of  life  about  us,  but  to  see  how  much 
we  can  add  to  it.  The  discontent  and  grumblings 
which  one  hears  have  their  source  in  the  man  more 
often  than  in  his  environment.  ^^ 


WORK  237 

Occasionally  a  man  of  superlative  merit  is  neglected,  Failure, 
but  it  is  because  he  lacks  that  most  essential  gift, 
the  knowledge  how  to  use  his  gifts.  The  failure  in 
99  per  cent,  of  the  cases  is  in  the  man  himself;  he 
has  not  started  right,  the  poor  chap  has  not  had 
the  choice  of  his  parents,  or  his  education  has 
been  faulty,  or  he  has  fallen  away  to  the  worship 
of  strange  gods,  Baal  or  Ashtoreth,  or  worse  still, 
Bacchus.  But  after  aU,  the  killing  vice  of  the 
young  doctor  is  laziness.  He  may  have  worked 
hard  at  college,  but  the  years  of  probation  have 
been  his  ruin.  Without  specific  subjects  upon 
which  to  work,  he  gets  the  newspaper  or  the  novel 
habit,  and  fritters  his  energies  upon  useless  literature. 
There  is  no  greater  test  of  a  man's  strength  than 
to  make  him  mark  time  in  the  '  stand  and  wait ' 
years.  Habits  of  systematic  reading  are  rare,  and 
are  becoming  more  rare,  and  five  or  ten  years  from 
his  hcence,  as  practice  begins  to  grow,  may  find 
the  young  doctor  knowing  less  than  he  did  when 
started,  and  without  fixed  educational  purpose  in 
life. '6 


MAN'S  YEARS  OF  USEFULNESS  AND 
HOW  HE  MAY  PROLONG  THEM 


•n  y  a  beaucoup  de  vieillards  k  quarante  ans  et  une 
infinite  de  jeunes  h.  soixante.'    (Laurens.) 


!40     MAN'S    YEARS    OF    USEFULNESS    AND 

Conserva-  Conservatism  and  old  fogeyism  are  totally  different 
fog^yiS^.°^*^  things ;  the  motto  of  the  one  is, '  Prove  all  things, 
and  hold  fast  that  which  is  good,'  and  of  the  other, 
'Prove  nothing,  but  hold  fast  that  which  is  old.' 
Do  not  suppose  that  you  have  here  a  monopoly  of 
the  article,  which  is  a  human,  not  a  national, 
malady,  for  we  see  a  very  virulent  type  in  America. 
In  its  illusiveness,  and  in  the  disastrous  consequences 
which  have  often  followed  its  hunting,  old  fogeyism 
is  a  sort  of  Snark  in  the  medical  profession.  Before 
this  Boojum,  in  the  form  of  an  entrenched  variety, 
many  good  men  and  true  have  softly  and  silently 
vanished  away  like  the  'beamish'  nephew  of  the 
bellman,  sacrificed  to  intellectual  staleness  in  high 
places.  One  of  the  best  correctives  is  the  plan 
followed  at  Harvard,  which  asks  every  teacher  to 
take  the  Sabbatical  year,  ensuring  in  this  way  rest 
of  the  mind,  if  not  refreshment.  To  maintain  mental 
freshness  and  plasticity  requires  incessant  vigilance ; 
too  often,  like  the  dial's  hand,  it  steals  from  its 
figure  with  no  pace  perceived — except  by  one's 
friends,  and  they  never  refer  to  it.  A  deep  and 
an  enduring  interest  in  the  manifold  problems  of 
medicine,  and  a  human  interest  in  the  affairs  of  our 
brotherhood ;  if  these  do  not  suffice  nothing  will. ' 

The  fossil-  After  all,  no  men  among  us  need  refreshment  and 
ized  teacher,  renovating  more  frequently  than  those  who  occupy 
positions  in  our  schools  of  learning.  Upon  none  does 
intellectual  staleness  more  readily  steal '  with  velvet 
step,  unheeded,  softly,'  but  none  the  less  relentlessly. 
Dogmatic  to  a  greater  or  less  degree  all  successful 


HOW  HE  MAY  PROLONG  THEM    24I 

teaching  must  be,  but  year  by  year,  unless  watchful, 
this  very  dogmatism  may  react  upon  the  teacher, 
who  finds  it  so  much  easier  to  say  to-day  what  he 
said  last  year.  After  a  decade  he  may  find  it  less 
trouble  to  draw  on  home  supplies  than  to  go  into 
the  open  market  for  wares,  perhaps  not  a  whit 
better,  but  just  a  wee  bit  fresher.  After  twenty 
years  the  new,  even  when  true,  startles,  too  often 
repels ;  after  thirty — well,  he  may  be  out  of  the  race, 
still  on  the  track  perhaps,  even  running  hard,  but 
quite  unconscious  that  the  colts  have  long  passed 
the  winning-post.  These  unrefreshed ,  unregenerate 
teachers  are  often  powerful  instruments  of  harm, 
and  time  and  again  have  spread  the  blight  of  blind 
conservatism  in  the  profession.  Safely  enthroned 
in  assured  positions,  men  of  strong  and  ardent 
convictions,  with  faithful  friends  and  still  more 
faithful  students,  they  too  often  come  within  the 
scathing  condemnation  of  the  blind  leaders  of  the 
blind,  of  those  who  would  neither  themselves  enter 
into  the  possession  of  new  knowledge  nor  suffer 
those  who  would  to  enter.  The  profession  has 
suffered  so  sorely  from  this  blight  of  old  fogeyism 
that  I  may  refer  to  the  most  glaring  instance  in 
our  history.  In  the  scientific  annals  of  this  great 
metropolis  there  is  no  occasion  more  memorable 
than  April  16,  16 16,  when  Harvey  began  his  re- 
volutionary teaching.  Why  the  long,  the  more 
than  Horatian  delay,  in  publishing  his  great  dis- 
covery ?  He  knew  his  day  and  generation,  and 
even  after  twelve  years  of  demonstration,  which 
should  have  disarmed  all  opposition,  we  know  how 

R 


24^ 


MAN  S   YEARS    OF    USEFULNESS   AND 


coldly  the  discovery  was  received,  particularly  in 
certain  quarters.  Harvey,  indeed,  is  reported  to 
have  said  that  he  did  not  think  any  above  forty 
years  of  age  had  accepted  the  new  truth.  Many  of 
us  have  lived  through  and  taken  part  in  two  other 
great  struggles.  The  din  of  batde  over  the  germ 
theory  of  disease  still  rings  in  our  ears.  Koch's 
brilliant  demonstration  of  the  tuberculosis  bacillus 
had  a  hard  uphill  fight  to  recognition.  The  vested 
interests  of  many  minds  were  naturally  against  it, 
and  it  was  only  the  watchers  among  us,  men  like 
Austin  Flint,  who  were  awake  when  the  dawn 
appeared.  It  is  notorious  that  the  great  principles 
of  antiseptic  surgery  have  grown  slowly  to  accept- 
ance, and  nowhere  more  slowly  than  in  the  country 
in  which  they  were  announced,  the  country  which 
has  the  great  honour  to  claim  Lord  Lister  as  a 
citizen.  Old  fogeyism  of  the  most  malignant  type 
stood  in  the  way,  and  in  some  places,  strange  to 
stay,  still  stands. ' 

Lacrlse  de  As  Locke  says :  '  Truth  scarce  ever  yet  carried 
it  by  vote  anywhere  at  its  first  appearance,'  and 
these  well-known  examples  illustrate  a  law  in 
human  knowledge  that  a  truth  has  to  grow  to 
acceptance  with  the  generation  in  which  it  is  an- 
nounced. Progress  is  an  outcome  of  a  never- 
ending  struggle  of  the  third  and  fourth  decades 
against  the  fifth,  sixth,  and  seventh.  Men  above 
forty  are  rarely  pioneers,  rarely  the  creators  in 
science  or  in  literature.  The  work  of  the  world 
has  been  done  by  men  who  had  not  reached  /a 


quaraate 
aas. 


HOW    HE    MAY    PROLONG   THEM 


2^ 

crise  de  quaranie  ans.  And  in  our  profession 
wipe  out,  with  but  few  exceptions,  the  contributions 
of  men  above  this  age  and  we  remain  essentially  as 
we  are.  Once  across  this  line  we  teachers  and 
consultants  are  in  constant  need  of  post-graduate 
study  as  an  antidote  against  premature  senility. 
Daily  contact  with  the  bright  young  minds  of  our 
associates  and  assistants,  the  mental  friction  of 
medical  societies,  and  travel  are  important  aids. 
Would  you  know  the  signs  by  which  in  man  or 
institution  you  may  recognize  old  fogeyism  ?  There 
are  three:  first,  a  state  of  blissful  happiness  and 
contentment  with  things  as  they  are ;  secondly, 
a  supreme  conviction  that  the  condition  of  other 
people  and  other  institutions  is  one  of  pitiable 
inferiority ;  and  thirdly,  a  fear  of  change,  which 
not  alone  perplexes  but  appals. ' 

X he    teacher's   life    should   have    three   periods :  Three 
study  until  twenty-five,  investigation   until   forty,  ^gteac^r's 
profession  until  sixty,  at  which  age  I  would  have  life, 
him  retired  on  a  double  allowance.  ^ 

Insensibly,  in   the   fifth  and  sixth  decades,  there  Presenility. 
begins  to  creep  over  most  of  us  a  change,  noted 
physically  among  other  ways  in  the  silvering  of         , 
the    hair  and   the  lessening  of  elasticity,   which 
impels  a  man  to  open  rather  than  to  vault  a  five- 
barred  gate.  '^ 

Harvey  complained  in  his  day  (i  578-1657)  that 
few  men  above  this  critical  age  (forty)  seemed  able 
R2 


MAN  S    YEARS    OF    USEFULNESS    AND 

to  accept  the  doctrine  of  the  circulation  of  the 
blood,  and  in  our  own  time  it  is  interesting  to  note 
how  the  theory  of  the  bacterial  origin  of  certain 
diseases  has  had,  as  other  truths,  to  grow  to  accept- 
ance with  the  generation  in  which  it  was  announced. 
The  only  safeguard  in  the  teacher  against  this 
lamentable  condition  is  to  live  in,  and  with,  the 
third  decade,  in  company  with  the  younger,  more 
receptive  and  progressive  minds.  ^^ 

When  a  man  nor  wax  nor  honey  can  bring  home, 
he  should,  in  the  interests  of  an  institution,  be  dis- 
solved from  the  hive  to  give  more  labourers  room  ; 
though  it  is  not  every  teacher  who  will  echo  the 
sentiment — 

'  Let  me  not  live  .  .  . 
After  my  flame  lacks  oil,  to  be  the  snuff 
Of  younger  spirits  whose  apprehensive  senses 
All  but  new  things  disdain.' 

As  we  travel  farther  from  the  East,  our  salvation 
lies  in  keeping  our  faces  toward  the  rising  sun, 
and  in  letting  the  fates  drag  us,  like  Cacus  his 
oxen,  backward  into  the  cave  of  oblivion.  ^^ 

Walk  with  One  thing  may  save  him  (from  becoming  useless  in 
the  young,  j^jg  advancing  years).  It  was  the  wish  of  Walter 
Savage  Landor  always  to  walk  with  Epicurus  on 
the  right  hand  and  Epictetus  on  the  left ;  and 
I  would  urge  the  clinical  physician,  as  he  travels 
farther  from  the  East,  to  look  well  to  his  com- 
panions— to  see  that  they  are  not  of  his  own  age 


HOW    HE    MAY    PROLONG    THEM  245 

and  generation.  He  must  walk  with  the  *  boys, 
else  he  is  lost,  irrevocably  lost ;  not  all  at  once,  but 
by  easy  grades,  and  every  one  perceives  his  ruin 
before  he,  *  good,  easy  man,'  is  aware  of  it.  I  would 
not  have  him  a  basil  plant,  to  feed  on  the  brains  of 
the  bright  young  men  who  follow  the  great  wheel 
uphill,  but  to  keep  his  mind  receptive,  plastic,  and 
impressionable  he  must  travel  with  the  men  who 
are  doing  the  work  of  the  world,  the  men  between 
the  ages  of  twenty-five  and  forty.  ^ 

After  years  of  hard  work,  at  the  very  time  when  The  calm, 
a  man's  energies  begin  to  flag,  and  when  he  feels  ^ot^™Pl^- 
the  need  of  more  leisure,  the  conditions  and  sur- 
roundings that  have  made  him  what  he  is  and  that 
have  moulded  his  character  and  abilities  into  some- 
thing useful  in  the  community — these  very  circum- 
stances ensure  an  ever-increasing  demand  upon 
them ;  and  when  the  call  of  the  East  comes,  which 
in  one  form  or  another  is  heard  by  all  of  us,  and 
which  grows  louder  as  we  grow  older,  the  call  may 
come  hke  the  summons  to  Elijah,  and  not  alone  the 
ploughing  of  the  day,  but  the  work  of  a  life,  friends, 
relatives,  even  father  and  mother,  are  left,  to  take 
up  new  work  in  a  new  field.  Or,  happier  far,  if 
the  call  comes,  as  it  did  to  Puran  Das  in  KipHng's 
story,  not  to  new  labours,  but  to  a  life  '  private, 
unactive,  calm,  contemplative.'  ■•* 


RELIGION,  DEATH,  AND  IMMORTALITY 


•  Life  is  a  pure  flame,  and  we  live  by  an  invisible  sun 
within  us.' 

'There  is  nothing  strictly  immortal,  but  immortality. 
Whatever  hath  no  beginning,  may  be  confident  of  no  end ' 
(all  others  have  a  dependent  being  and  are  within  the  reach 
of  destruction) ;  « which  is  the  peculiar  of  that  necessary 
Essence  that  cannot  destroy  itself;  and  the  highest  strain 
of  omnipotency,  to  be  so  powerfully  constituted  as  not  to 
suffer  even  from  the  power  of  itself.'  (Sir  Thomas  Browne, 
Hydriotapbla—Urn  Burial.) 


248 


RELIGION,    DEATH 


Science  and    And  thirdly,  every  one  of  you  will  have  to  face 
faith.  ^j^g  ordeal  of  every  student  in  this  generation  who 

sooner  or  later  tries  to  mix  the  waters  of  science 
with  the  oil  of  faith.  You  can  have  a  good  deal  of 
both  if  you  only  keep  them  separate.  The  worry 
comes  from  the  attempt  at  mixture.  As  general 
practitioners  you  will  need  all  the  faith  you  can 
carry,  and  while  it  may  not  always  be  of  the  con- 
ventional pattern,  when  expressed  in  your  lives 
rather  than  on  your  lips,  the  variety  is  not  a  bad 
one  from  the  standpoint  of  St.  James;  and  may 
help  to  counteract  the  common  scandal  alluded 
to  in  the  celebrated  diary  of  that  gossipy  old 
pastor-doctor,  the  Rev.  John  Ward  :  '  One  told  the 
Bishop  of  Gloucester  that  he  imagined  physicians 
of  all  other  men  the  most  competent  judges  of 
affairs  of  religion,  and  his  reason  was  because  they 
were  wholly  unconcerned  with  it.'  '* 

All  lovers  of  poetry  cherish  Keats's  memory  for  the 
splendour  of  the  verse  with  which  he  has  enriched 
our  literature.  There  is  also  that  deep  pathos 
in  a  life  cut  off  in  the  promise  of  such  rich  fruit. 
He  is  numbered  among  '  the  inheritors  of  un- 
fulfilled renown,'  with  Catullus  and  Marlowe,  with 
Chatterton  and  Shelley,  whom  we  mourn  as  doubly 
dead  in  that  they  died  so  young.  '^ 

'  W^ith  what  strife  and  pains  we  come  into  the 
world  we  know  not,  but  it  is  commonly  no  easy 
matter  to  get  out  of  it,'  Sir  Thomas  Browne  says ; 
and,  having  regard  to  the  uncertainties  of  the  last 


The  pathos 
of  early 
death. 


Sudden 
death. 


AND    IMMORTALITY  249 

Stage  of  all,  the  averag-e  man  will  be  of  Caesar's 
opinion,  who,  when  questioned  at  his  last  dinner- 
party as  to  the  most  preferable  mode  of  death, 
replied,  '  That  which  is  the  most  sudden.'  Against 
this,  one  in  a  string  of  grievous  calamities,  we  pray 
in  the  Litany,  though  De  Quincey  insists  that  the 
meaning  here  is  '  unprepared.'  In  this  sense  sudden 
death  is  rare  in  angina  pectoris,  since  the  end  comes 
but  seldom  in  the  first  paroxysm.  Terrible  as  are 
some  of  these  incidental  conditions  accompanying 
coronary  artery  lesions,  there  is  a  sort  of  kindly 
compensation,  as  in  no  other  local  disease  do  we  so 
often  see  the  ideal  death — death,  like  birth, '  a  sleep 
and  a  forgetting.'  '^ 

Angina  Pectoris  Vera,  Heredity.  The  best-known  Matthew 
instance  is  that  of  the  Arnold  family.  William  -^^f^^^'* 
Arnold,  collector  of  customs  of  Cowes,  died  sud- 
denly of  spasm  of  the  heart  in  1801.  His  son,  the 
celebrated  Thomas  Arnold,  of  Rugby,  .  .  .  died  in 
his  first  attack.  Matthew  Arnold,  his  distinguished 
son,  was  a  victim  of  the  disease  for  several  years, 
and  died  suddenly  in  an  attack  on  Sunday,  April  15, 
1888,  having  been  spared,  as  he  hopes  in  his  little 
poem  called  A  Wtsh^ — 

'the  whispering,  crowded  room. 
The  friends  who  come,  and  gape,  and  go; 
The  ceremonious  air  of  gloom — 

All,  which  makes  death  a  hideous  show ! '  ""^ 

Than  the  physician,  no  one  has  a  better  oppor-  "^^^^^^^r. 
tunity  to  study  the  attitude  of  mind  of  his  fellow  problem. 


250 


RELIGION,    DEATH 


'  Clean  for- 
gotten, like 
the  dead 
man  out  of 
mind.' 


Communion 
of  Saints 
and 

the  busy 
life. 


men  on  the  problem.  Others,  perhaps,  get  nearer 
to  John,  taking  no  thought  for  the  morrow,  as 
he  disports  himself  in  the  pride  of  life ;  but  who 
gets  so  near  to  the  real  John  as  known  to  his 
Maker,  to  John  in  sickness  and  in  sorrow,  and  sore 
perplexed  as  to  the  future  ?  The  physician's  work 
lies  on  the  confines  of  the  shadow-land,  and  it  might 
be  expected  that,  if  to  any,  to  him  would  come 
glimpses  that  might  make  us  less  forlorn  when 
in  the  bitterness  of  loss  we  cry : — 

'  Ah,  Christ  1  that  it  were  possible 
For  one  short  hour  to  see 
The  souls  we  loved,  that  they  might  tell  us 
What  and  where  they  be  ! '  ^' 

V\^  habitually  talk  of  the  departed,  not  as  though 
they  had  passed  from  death  unto  life  and  were 
in  a  state  of  conscious  joy  and  felicity,  or  other- 
wise, but  we  count  them  out  of  our  circle  with 
set  deliberation,  and  fix  between  them  and  us 
a  gulf  as  deep  as  that  which  separated  Dives  from 
Lazarus.  That  sweet  and  gracious  feeling  of  an 
ever-present  immortality,  so  keenly  appreciated  in 
the  religion  of  Numa,  has  no  meaning  for  us.  The 
dead  are  no  longer  immanent,  and  we  have  lost 
that  sense  of  continuity  which  the  Romans  ex- 
pressed so  touchingly  in  their  private  festivals 
of  the  Ambarvalia,  in  which  the  dead  were  invoked 
and  remembered.  Even  that  golden  cord  of  Catholic 
doctrine,  the  Communion  of  the  Saints,  so  comfort- 
ing to  the  faithful  in  all  ages,  is  worn  to  a  thread  in 
our  working-day  world.     Over  our  fathers  immor- 


AND    IMMORTALITY  25I 

tality  brooded  like  the  day ;  we  have  consciously 
thrust  it  out  of  lives  so  full  and  busy  that  we  have 
no  time  to  make  an  enduring  covenant  with  our 
dead.  ^^ 

As  a  rule,  man  dies  as  he  had  lived,  uninfluenced  How  man 
practically  by  the  thought  of  a  future  life.     Bunyan  *^^* 
could   not  understand    the    quiet,   easy  death   of 
Mr.  Badman,  and  took  it  as  an  incontestable  sign 
of  his  damnation.     The  ideal  death  of  Cornelius, 
so  beautifully  described  by  Erasmus,  is  rarely  seen. 
In  our  modern  life  the  educated  man  dies  usually 
as  did  Mr.  Denner  in  Margaret  Deland's  story — 
wondering,  but  uncertain,  generally   unconscious 
and  unconcerned.     I  have  careful  records  of  about 
five  hundred  death-beds,  studied  particularly  with 
reference  to  the  modes  of  death  and  the  sensations 
of  the  dying.     The  latter  alone  concern  us  here. 
Ninety  suffered  bodily  pain  and  distress  of  one  sort 
or  another,  eleven  showed  mental  apprehension, 
two  positive  terror,  one  expressed  spiritual  exalta- 
tion, one  bitter  remorse.     The  great  majority  gave 
no  sign  one  way  or  the  other;   like  their  birth, 
their  death  was  '  a  sleep  and  a  forgetting.'    The 
Preacher  was  right :  in  this  matter  man  hath  no 
pre-eminence  over  the  beast — '  as  the  one  dieth, 
so  dieth  the  other.'  ^^^ 

The   search  of  science  for  the  spirits  has  been  Science  and 
neither  long  nor  earnest ;  nor  is  it  a  matter  of  sur-  ^^^  spirits, 
prise  that  it  has  not  been  undertaken  earlier  by 
men  whose  training  had  fitted  them  for  the  work. 


252  RELIGION,    DEATH 

It  is  no  clear,  vasty  deep,  but  a  muddy,  Acheronian 
pool  in  which  our  modern  spirits  dwell,  with  Circe 
as  the  presiding  deity  and  the  Witch  of  En-dor 
as  her  high  priestess.  Commingling  with  the 
solemn  incantations  of  the  devotees  who  throng 
the  banks,  one  can  hear  the  mocking  laughter  of 
Puck  and  of  Ariel,  as  they  play  among  the  sedges 
and  sing  the  monotonous  refrain,  '  What  fools  these 
mortals  be!  '  Sadly  besmirched,  and  more  fitted 
for  a  sojourn  in  Ancyra  than  in  Athens,  has  been 
the  condition  of  those  who  have  returned  from  the 
quest,  and  we  cannot  wonder  that  scientific  men 
have  hesitated  to  stir  the  pool  and  risk  a  touch 
from  Circe's  wand.  All  the  more  honour  to  those 
who  have  with  honest  effort  striven  to  pierce  the 
veil  and  explore  the  mysteries  which  lie  behind  it.  ^' 

The  immor-  Science  has  put  on  an  immortality  of  the  flesh,  and 
tality  of  the  j^  ^  remarkable  triumph  of  research  has  learned  to 
recognize  in  every  living  being  at  once  immortal 
age  beside  immortal  youth.  The  patiently  worked- 
out  story  of  the  morphological  continuity  of  the 
germ -plasm  is  one  of  the  fairy  tales  of  science. 
You  who  listen  to  me  to-day  feel  organized  units 
in  a  generation  with  clear-cut  features  of  its  own, 
a  chosen  section  of  the  finely  woven  fringe  of  life 
built  on  the  coral  reef  of  past  generations, — and, 
perhaps,  if  any,  you  citizens  of  no  mean  city  have 
a  right  to  feel  of  some  importance.  The  revela- 
tions of  modern  embryology  are  a  terrible  blow  to 
this  pride  of  descent.  The  individual  is  nothing 
more  than  the  transient  offshoot  of  a  germ -plasm, 


AND    IMMORTALITY  253 

which  has  an  unbroken  continuity  from  generation 
to  generation,  from  age  to  age.  This  marvellous 
embryonic  substance  is  eternally  productive,  eter- 
nally forming  new  individuals  to  grow  up  and 
to  perish,  while  it  remains  in  the  progeny  always 
youthful,  always  increasing,  always  the  same. 
'  Thousands  upon  thousands  of  generations  which 
have  arisen  in  the  course  of  ages  were  its  products, 
but  it  lives  on  in  the  youngest  generations  with  the 
power  of  giving  origin  to  coming  millions.  The 
individual  organism  is  transient,  but  its  embryonic 
substance,  which  produces  the  mortal  tissues, 
preserves  itself,  imperishable,  everlasting,  and 
constant.'  ^' 

Though  his  philosophy  finds  nothing  to  support  it.  Value  of  a 
at  least  from  the  standpoint  of  Terence  the  scientific  ^^^^^ij. 
student  should  be  ready  to  acknowledge  the  value 
of  a  belief  in  a  hereafter  as  an  asset  in  human  life. 
In  the  presence  of  so  many  mysteries  which  have 
been  unveiled,  in  the  presence  of  so  many  yet 
unsolved,  he  cannot  be  dogmatic  and  deny  the 
possibility  of  a  future  state ;  and  however  distress- 
ing such  a  negative  attitude  of  mind  to  the  Teresian, 
like  Pyrrho,  he  will  ask  to  be  left,  reserving  his 
judgement,  but  still  inquiring.  He  will  recognize 
that  amid  the  turbid  ebb  and  flow  of  human  misery, 
a  belief  in  the  resurrection  of  the  dead  and  the  life 
of  the  world  to  come  is  the  rock  of  safety  to  which 
many  of  the  noblest  of  his  fellows  have  clung  ;  he 
will  gratefully  accept  the  incalculable  comfort  of 
such  a  belief  to  those  sorrowing  for  precious  friends 


254     RELIGION,    DEATH,    AND    IMMORTALITY 

hid  in  death's  dateless  night ;  he  will  acknowledge 
with  gratitude  and  reverence  the  service  to  humanity 
of  the  great  souls  who  have  departed  this  life  in 
a  sure  and  certain  hope — but  this  is  all.  Whether 
across  death's  threshold  we  step  from  life  to  life,  or 
whether  we  go  whence  we  shall  not  return,  even  to 
the  land  of  darkness,  as  darkness  itself,  he  cannot 
tell.  3- 

Coafessio       On  the  question  before  us  wide  and  far  your  hearts 
"oei.  ^m  range  from  those  early  days  when  matins  and 

evensong,  evensong  and  matins,  sang  the  larger 
hope  of  humanity  into  your  young  souls.  In  certain 
of  you  the  changes  and  chances  of  the  years  ahead 
will  reduce  this  to  a  vague  sense  of  eternal  con- 
tinuity, with  which,  as  Walter  Pater  says,  none  of 
us  wholly  part.  In  a  very  few  it  will  be  begotten 
again  to  the  lively  hope  of  the  Teresians ;  while 
a  majority  will  retain  the  sabbatical  interest  of  the 
Laodicean,  as  little  able  to  appreciate  the  fervid 
enthusiasm  of  the  one  as  the  cold  philosophy  of 
the  other.  Some  of  you  will  wander  through  all 
phases,  to  come  at  last,  I  trust,  to  the  opinion  of 
Cicero,  who  had  rather  be  mistaken  with  Plato 
than  be  in  the  right  with  those  who  deny  altogether 
the  life  after  death ;  and  this  is  my  own  confessio 


VARIA 


256  VARIA 

Parting.  Of  course  upon  a  few  the  sense  of  personal  loss 

falls  heavily;  the  faculty  of  getting  attached  to 
those  with  whom  we  work  is  strongly  developed 
in  most  of  us,  and  some  will  realize  the  bitterness 
of  the  lines : — 

'Alas!   that  all  we  loved  of  him  should  be 
But  for  our  grief  as  if  it  had  not  been.'** 

Common  sense  in  matters  medical  is  rare,  and  Is 
usually  in  inverse  ratio  to  the  degree  of  education.  ^^ 

<^ 

AVhen  schemes  are  laid  in  advance,  it  Is  surprising 
how  often  the  circumstances  fit  in  with  them.  ^ 

In  the  life  of  every  successful  physician  there  comes 
the  temptation  to  toy  with  the  Delilah  of  the  press, 
daily  and  otherwise.  There  are  times  when  she 
may  be  courted  with  satisfaction,  but  beware! 
sooner  or  later  she  is  sure  to  play  the  harlot,  and 
has  left  many  a  man  shorn  of  his  strength,  viz.  the 
confidence  of  his  professional  brethren.  ^ 

Equanimity.  One  of  the  first  essentials  in  securing  a  good- 
natured  equanimity  is  not  to  expect  too  much  of 
the  people  amongst  whom  you  dwell.  ^° 

From  two  points  alone  have  we  a  wide  and 
satisfactory  view  of  life — one,  as  amid  the  glorious 
tint  of  the  early  morn,  ere  the  dew  of  youth  has 
been  brushed  off,  we  stand  at  the  foot  of  the  hill, 
eager  for  the  journey ;  the  other,  wider,  perhaps 


Common 

sense. 


The  future. 


Delilah  of 
the  press. 


Two  views 
in  life. 


VARIA  257 

less  satisfactory,  as  we  gaze  from  the  summit  at 
the  lengthening  shadows  cast  by  the  setting  sun. 

You  remember  in  the  ascent  of  the  Mountain  of 
Purgatory,  Dante,  after  a  difficult  climb,  reached 
a  high  terrace  encircling  the  hill,  and  sitting  down 
turned  to  the  east,  remarking  to  his  conductor,  '  All 
men  are  deh'ghted  to  look  back.'  So  on  this 
occasion,  from  the  terrace  of  a  quarter  of  a  century, 
I  am  delighted  to  look  back,  and  to  be  able  to  tell 
you  of  the  prospect.  '^ 

The  gospel  of  '  living '  as  against  that  of  '  doing,'  The  gospel 
which  Milton  preached  in  the  celebrated  sonnet  On  °^  "^^S- 
/^ts  Blindness^  found  in  Keats  a  warm  advocate. 
'  Let  us  not,  therefore,'  he  says,  '  go  hurrying  about 
and  collecting  honey,  bee-like  buzzing  here  and 
there  for  a  knowledge  of  what  is  not  to  be  arrived 
at,  but  let  us  open  our  leaves  like  a  flower,  and  be 
passive  and  receptive,  budding  patiently  under  the 
eye  of  Apollo,  and  taking  truths  from  every  noble 
insect  that  favours  us  with  a  visit.'  Fatal  to  en- 
courage in  an  active  man  of  affairs,  this  dreamy 
state,  this  passive  existence,  favours  in  '  bards  of 
passion  and  of  mirth '  the  development  of  a  fruitful 
mental  attitude.  '^ 

The  dreamer  spins  from  his  *  own  Inwards  his  own  The 
airy  citadel';    and  as  the  spider   needs   but   few  ^®^™sr* 
points  of  leaves  and  twigs  from  which  to  begin  his 
airy  circuit,  so  Keats  says,  '  man  should  be  content 
with  as  few  points  to  tip  with  the  fine  web  of  his 
soul,  and  weave  a  tapestry  empyrean,  full  of  symbols 

3 


258 


VARIA 


Mind  the 
measure  of 
man. 


for  his  spiritual  eye,  of  softness  for  his  spiritual 
touch,  of  space  for  his  wanderings,  of  distinctness 
for  his  luxury.'  '^ 

<^ 

Who  has  not  known  lives  of  the  greatest  freshness 
and  nobility  hampered  at  every  turn  and  bound  in 
chains  the  most  commonplace  and  sordid,  lives 
which  illustrate  the  liberty  and  freedom  enjoyed  by 
minds  innocent  and  quiet,  in  spite  of  stone  walls 
and  iron  bars  ?  On  the  other  hand,  scan  the  history 
of  progress  in  the  profession,  and  men  the  most 
liberal  and  narrow,  reeking  of  the  most  pernicious 
type  of  chauvinism,  have  been  among  the  teachers 
and  practitioners  in  the  large  cities  and  great 
medical  centres ;  so  true  is  it,  that  the  mind  is  its 
own  place  and  in  itself  can  make  a  man  independent 
of  his  environment.  ""^ 


The  credu- 
lous public. 


'Knowledge  comes,  but  wisdom  lingers,'  and  in 
matters  medical  the  ordinary  citizen  of  to-day  has 
not  one  whit  more  sense  than  the  old  Romans, 
whom  Lucian  scourged  for  a  credulity  which  made 
them  fall  easy  victims  to  the  quacks  of  the  time, 
such  as  the  notorious  Alexander,  whose  exploits 
make  one  wish  that  his  advent  had  been  delayed 
some  eighteen  centuries.  ^° 

Curious,  odd  compounds  are  these  fellow  creatures, 
at  whose  mercy  you  will  be ;  full  of  fads  and 
eccentricities,  of  whims  and  fancies ;  but  the  more 
closely  we  study  their  little  foibles  of  one  sort  and 
another  in  the  inner  life  which  we  see,  the  more 


VARIA  259 

surely  is  the  conviction  borne  in  upon  us  of  the 
likeness  of  their  weaknesses  to  our  own.  ='° 

Deal  gently  then  with  this  deliciously  credulous 
old  human  nature  in  which  we  work,  and  restrain 
your  indignation,  when  you  find  your  pet  parson  has 
triturates  of  the  hundredth  potentiality  in  his  waist- 
coat pocket,  or  you  discover  accidentally  a  case  of 
Warner's  Safe-Cure  in  the  bedroom  of  your  best 
patient.  It  must  needs  be  that  offences  of  this 
kind  come ;  expect  them,  and  do  not  be  vexed.  ^° 

Hence  the  need  of  an  infinite  patience  and  of  an 
over-tender  charity  towards  these  fellow  creatures  ; 
have  they  not  to  exercise  the  same  toward  us  ?  ^° 

Sometimes  from  our  desolation  only  does  a  better  Inexorable 
life  begin.  Surely  the  blood  penalty  has  been  paid  Nature : 
in  full  for  the  gross  neglect  of  sanitary  laws.  The 
wantonness  of  the  sacrifice  is  so  terrible,  so  in- 
human. Nature  is  inexorable,  and  red  in  tooth 
and  claw  with  ravin,  knows  nothing  of  our  humani- 
tarian care  of  the  individual.  But  her  sacrifice  is 
never  wanton.  Careful  of  the  type,  careless  of  the 
single  life,  sacrifice  is  a  law  of  being,  a  condition  of 
existence.     In  one  of  his  delightful  lectures  on  the  cares  for  the 

Foundations  of  Zoolop-y,  Professor  Brooks  tells  us  species 

while  the 
that  of  the  countless  millions  of  the  king  of  fish  physician 

which  yearly  enter  the  Columbia  River  seeking  the  cares  for  the 

breeding-grounds,   in   the  stern   impulse  of   pro-  "^   ^i  u   . 

pagation,  none  return.     '  The  whole  race  is  wiped 

out,  utterly  exterminated,  as  soon  as  it  arrives  at 

S2 


26o 


VARIA 


Lives  offered 
on  the  altars 
of  Ignorance 
and  Neglect. 


ADelian 
sacrifice. 


Limitations 
of  the  art. 


maturity  and  physical  perfection  in  order  that  the 
perpetuation  of  the  species  may  be  assured.'  Our 
ways,  thank  God,  are  not  Nature's.  Indulge  as  we 
may  in  speculations  on  the  improvement  of  the 
race,  in  practice  we  care  nothing  for  the  species, 
only  for  the  individual.  Reversing  Nature's  method, 
we  are  careless  of  the  type,  careful  only  of  the 
single  life.  Year  by  year  unwilling  witnesses  of  an 
appalUng  sacrifice,  as  fruitless  as  it  is  astounding, 
year  by  year  we  physicians  sit  at  the  bedsides  of 
thousands  upon  thousands,  chiefly  of  youths  and 
maids,  whose  lives  are  offered  up  on  the  altars  of 
Ignorance  and  Neglect.  Walking  always  in  its 
shadow,  compassed  always  by  its  sorrows,  we  learn 
to  look  on  death  with  mingled  feelings.  There 
is  the  death  that  comes  with  friendly  care  to  the 
aged,  to  the  chronic  invalid,  or  to  the  sufferer  with 
some  incurable  malady.  Very  different,  indeed,  is 
it  with  typhoid  fever.  A  keen  sense  of  personal 
defeat  in  a  closely  contested  battle,  the  heart- 
searching  dread  lest  something  had  been  left  un- 
done, the  pitifulness  of  the  loss,  so  needless — and 
as  a  rule  '  in  the  morn  and  liquid  dew  of  youth ' — 
the  poignant  grief  of  parents  and  friends  worn  out 
by  the  strain  of  anxious  days  and  still  more  anxious 
nights — these  make  us  feel  a  death  from  typhoid 
fever  to  be  a  Delian  sacrifice.  ^^ 

We  recognize  to-day  the  limitations  of  the  art; 
we  know  better  the  diseases  curable  by  medicine, 
and  those  which  yield  to  exercise  and  fresh 
air ;  we  have  learned  to  realize  the  intricacy  of  the 


VARIA  261 

processes  of  disease,  and  have  refused  to  deceive 
ourselves  with  half-knowledge,  preferring  to  wait 
for  the  day  instead  of  groping  blindly  in  the  dark 
or  losing  our  way  in  the  twilight.  The  list  of 
diseases  which  we  can  positively  cure  is  an  ever- 
increasing  one ;  the  number  of  diseases  the  course 
of  which  we  can  modify  favourably  is  a  growing 
one ;  the  number  of  incurable  diseases  (which  is 
large,  and  which  will  probably  always  be  large)  is 
diminishing.  *^ 

One  of  the  most  remarkable  and  beneficial  reforms  Insanity, 
of  the  nineteenth  century  has  been  in  the  attitude 
of  the  profession  and  the  public  to  the  subject  of 
insanity,  and  the  gradual  formation  of  a  body  of 
men  in  the  profession  who  labour  to  find  out  the 
cause  and  the  means  of  relief  of  this  most  distressing 
of  all  human  maladies.  The  reform  movement  in- 
augurated by  Tuke  in  England,  by  Rush  in  the 
United  States,  by  Pinol  and  Esquirol  in  France, 
and  by  Jacobi  and  Hasse  in  Germany,  has  spread  to 
all  civilized  countries,  and  has  led  not  only  to  the 
amelioration  and  improvement  in  the  care  of  the 
insane,  but  to  a  scientific  study  of  the  subject  which 
has  already  been  productive  of  much  good.  In 
this  country,  while  the  treatment  of  the  insane  is 
careful  and  humanitarian,  the  unfortunate  affiliation 
of  insanity  with  politics  is  still  in  many  States  a 
serious  hindrance  to  progress.  ^ 

^  Doctor  and 

There  are  individuals — doctors  and  nurses,  for  ex-  nurse- 
ample — whose  very  existence  is  a  constant  reminder  ^^^^ 


262  VARIA 

of  our  frailties;  and  considering  the  notoriously 
irritating  character  of  such  people,  I  often  wonder 
that  the  world  deals  so  gently  with  them. 

The  presence  of  the  parson  suggests  dim  possi- 
bilities, not  the  grim  realities  conjured  up  by  the 
names  of  the  persons  just  mentioned ;  the  lawyer 
never  worries  us  in  this  way,  and  we  can  imagine  in 
the  future  a  social  condition  in  which  neither  divinity 
nor  law  shall  have  a  place,  when  all  shall  be  friends 
and  each  one  a  priest,  when  the  meek  shall  possess 
the  earth  ;  but  we  cannot  picture  a  time  when  birth, 
and  life,  and  death  shall  be  separated  from  that 
'  grizzly  troop  '  which  we  dread  so  much,  and  which 
is  ever  associated  in  our  minds  with  '  physician  and 
nurse.'  ^'* 

Intemper-  And  a  third  factor,  most  Important  of  all,  illustrates 
the  old  maxim,  that  more  people  are  killed  by 
over- eating  and  drinking  than  by  the  sword. 
Sensible  people  have  begun  to  realize  that  alcoholic 
excesses  lead  inevitably  to  impaired  health.  ^ 


A  man  may  take  four  or  five  drinks  of  whisky 
a  day,  or  even  more,  and  think  perhaps  he  transacts 
his  business  better  with  that  amount  of  stimulant ; 
but  it  only  too  frequendy  happens  that  early  in  the 
fifth  decade,  just  as  business  or  political  success 
is  assured,  Bacchus  handls  in  heavy  bills  for  payment, 
in  the  form  of  serious  disease  of  the  arteries  or 
of  the  liver,  or  there  is  a  general  break-down.  ^ 


ance. 


VARIA  263 

While  temperance  in  the  matter  of  alcoholic 
drinks  is  becoming-  characteristic  of  Americans, 
intemperance  in  the  quantity  of  food  taken  is 
almost  the  rule.  Adults  eat  far  too  much ;  the 
physicians  are  beginning-  to  recognize  that  early 
degenerations,  particularly  of  the  arteries  and  of 
the  kidneys,  leading  to  Bright's  disease,  which 
were  formally  attributed  to  alcohol,  are  due  in  large 
part  to  too  much  food.  ^ 

(i)  Unanimity  of  opinion  has  not  been  reached  Alcohol. 
on  the  question  of  alcohol  as  a  food ;  the  balance 
of  evidence  is  in  favour  of  the  view  that  it  does 
so  act. 

(2)  A  healthy  man  does  not  require  alcoholic 
stimulants  of  any  kind. 

(3)  So  far  as  actual  damage  to  the  machine, 
a  moderate  quantity  of  beer  or  spirits,  taken  at 
luncheon  or  dinner,  seems  to  have  no  special  in- 
fluence one  way  or  another. 

(4)  The  danger  lies  in  excess,  but  this  is  not 
easy  to  define.  A  man  who  drinks  between  meals 
drinks  too  much.  A  man  who  takes  three  or  four 
glasses  of  spirits  daily  is  certainly  drinking  to 
excess.  He  may  feel  no  ill  effects  at  the  time, 
but  continued  for  years  the  practice  may  damage 
seriously  his  constitution.  To  get  the  necessary 
satisfaction  he  must  inevitably  increase  the  daily 
amount,  and  such  a  man  is  always  confronted  by 
the  terrible  danger  of  permanent  enslavement. 

Shakespeare  gets  to  the  root  of  the  alcohol 


264  VARIA 

question  in  his  well-known  statement — '  Good  wine 
is  a  good,  familiar  creature  if  it  be  well  used.""^ 


Style  in  Naturally  studious,  fond  of  poetry,  history,  bio- 

writing.  graphy,  and  literature  in  general,  and  not  for  long 
tied  and  bound  in  the  chains  of  general  practice, 
Bartlett  had  ample  opportunities  to  cultivate  his 
mind.  He  says  in  one  of  his  letters  to  Green 
(dated  Pittsfield,  Nov.  i,  1835): — 'I  pass  a  good 
deal  of  my  time  here  quite  alone,  so  that  I  find 
myself  whiling  away  the  hours  in  meditation  much 
oftener  than  when  engaged  in  the  more  varied  and 
active  affairs  of  business  at  home.  I  think  that 
I  always  leave  Pittsfield  with  the  better  and  purer 
part  of  my  being  somewhat  strengthened.'  Burton 
concludes  his  immortal  treatise  with  the  advice, 
'  Be  not  solitary,  be  not  idle,'  but  the  true  student, 
in  some  part  of  his  life  at  least,  should  know  the 
'  fruitful  hours  of  still  increase.'  For  many  years 
Bartlett  enjoyed  a  leisure  known  to-day  to  few 
professors  of  medicine,  the  fruits  of  which  are 
manifest  in  his  writings.  Among  his  contem- 
poraries in  the  profession  there  were  brilliant 
writers — Samuel  Henry  Dickson,  Jacob  Bigelow, 
J.  K.  Mitchell — but  in  a  style  so  uniformly  high 
and  polished,  yet  withal  so  plain,  not  one  of  them 
approached  Bartlett.  Compare,  for  example, 
Samuel  Jackson's  Principles  of  Medicine^  written 
in  1832,  with  the  first  edition  of  the  Fevers  (1842) — 
the  one  pompous,  involved,  obscure ;  the  other 
clear,  direct,  simple.      For  style  in  his  medical 


VARIA  265 

writings  Bartlett  may  be   called  the  Watson  or 
the  Trousseau  of  America.  '*^ 


We  have  the  very  highest  authority  for  the  state-  Poetry— 
ment  that '  the  lunatic,  the  lover,  and  the  poet,  are  ^  divine 
of  imagination  all  compact.'  In  a  more  compre- 
hensive division,  with  a  keener  discernment,  Plato 
recognizes  a  madness  which  is  not  an  evil,  but 
a  divine  gift,  and  the  source  of  the  chiefest  blessings 
granted  to  men.  Of  this  divine  madness  poetry 
occupies  one  of  the  fourfold  partitions.  Here  is 
his  definition : — 

'  The  third  kind  is  the  madness  of  those  who 
are  possessed  by  the  Muses ;  which,  taking  hold 
of  a  delicate  and  virgin  soul,  and  there  inspiring 
frenzy,  awakens  lyrical  and  all  other  numbers; 
with  these  adorning  the  myriad  actions  of  ancient 
heroes  for  the  instruction  of  posterity.  But  he 
who,  having  no  touch  of  the  Muses'  madness  in  his 
soul,  comes  to  the  door  and  thinks  that  he  will  get 
into  the  temple  by  the  help  of  art — he,  I  say,  and 
his  poetry  are  not  admitted ;  the  sane  man  dis- 
appears and  is  nowhere  when  he  enters  into  rivalry 
with  the  madman.'  '^ 


Here,  in  a  few  words,  we  have  expressed  the  very  The  poet's 
pith  and  marrow  of  the  nature  of  poetry,  and  a  S*^ 
clearer  distinction  than  is  drawn  by  many  modern 
writers  of  the  relation  of  the  art  to  the  spirit,  of  the 
form  to  the  thought.  By  the  help  of  art,  without 
the  Muses'  madness,  no  man  enters  the  temple. 
The  poet  is  a  '  light  and  winged  and  holy  thing,' 


266  VARIA 

whose  inspiration,  genius,  faculty,  whatever  we 
may  choose  to  call  it,  is  allied  to  madness — he  is 
possessed  or  inspired.  Oliver  Wendell  Holmes 
has  expressed  this  very  charmingly  in  more  modern 
terms,  speaking  of  his  own  condition  when  com- 
posing the  Chambered  Nautilus  :  '  In  writing  the 
poem  I  was  filled  with  a  better  feeling,  the  highest 
state  of  mental  exaltation  and  the  most  crystalline 
clairvoyance  that  had  ever  been  granted  to  me — 
I  mean  that  lucid  vision  of  one's  thought  and  all 
forms  of  expression  which  will  be  at  once  precise 
and  musical,  which  is  the  poet's  special  gift,  how- 
ever large  or  small  in  amount  or  value.'  To  the 
base  mechanical  of  the  working-day  world,  this 
lucid  vision,  this  crystalline  clairvoyance  and  men- 
tal exaltation  is  indeed  a  madness  working  in  the 
brain,  a  state  which  he  cannot  understand,  a  Holy 
of  Holies  into  which  he  cannot  enter.  '^ 


Verse-writ-  It  is  remarkable  how  many  physicians  write  poetry, 
!."f„o  ^^"  °^  what  passes  as  such.  I  have  been  told  of  a 
period  in  the  history  of  the  Royal  College  of 
Physicians  of  London  when  every  elect  (censor),  as 
they  were  called,  had  written  verses.  Some  begin 
young,  as  did  Bartlett ;  others  become  attuned  in 
the  deep  autumnal  tone  of  advancing  years,  when, 
as  Plato  tells  us  in  the  Phaedo,  even  Socrates  felt 
a  divine  impulsion  to  make  verses  before  quitting 
the  prison-house.  Those  of  us  who  have  read  the 
,  epic  of  the  late  distinguished  Professor  George  B. 
Wood,  of  the  University  of  Pennsylvania,  entitled, 


cians. 


VARIA  267 

First  and  Last^  published  when  he  was  sixty-four, 
will  devoutly  hope  that  professors  of  medicine, 
when  afflicted  with  this  form  of  madness,  will 
follow  his  example  and  publish  their  poems  anony- 
mously and  in  another  country.  Jacob  Bigelow, 
too,  when  nearly  seventy, '  darkened  sanctities  with 
song'  with  his  American  Rejected  Addresses.*"^ 
{Eolopoesis^ 

All  the  while  Keats  was '  budding-  patiently,'  feeling  His  master- 
his  powers  expand,  and  with  the  '  viewless  winged  passion. 
Poesy '  taking  ever  larger  flights.  An  absorption 
in  ideals,  a  yearning  passion  for  the  beautiful,  was, 
he  says,  his  master-passion.  Matthew  Arnold  re- 
marks it  was  with  him  '  an  intellectual  and  spiritual 
passion.'  It  is  'connected  and  made  one,'  as 
Keats  declares  that  in  his  case  it  was,  'with  the 
ambition  of  the  intellect.'  '  It  is,'  as  again  he 
says,  '  the  mighty  abstract  idea  of  Beauty  in  all 
things.'  '^ 

Listen  to  one  or  two  striking  passages  from  his  Beauty  is 
letters : — '  This  morning  Poetry  has  conquered, —  truth. 
I  have  relapsed  into  those  abstractions  which  are 
my  only  life.'  '  I  feel  more  and  more  every  day,  as 
my  imagination  strengthens,  that  I  do  not  live  in 
this  world  alone,  but  in  a  thousand  worlds.  No 
sooner  am  I  alone  than  shapes  of  epic  greatness  are 
stationed  around  me,  and  serve  my  spirit  the  office 
which  is  equivalent  to  a  king's  body-guard.  Then 
"  Tragedy  with  scepter'd  pall  comes  sweeping  by."  ' 


268  VARIA 

'  What  the  imagination  seizes  as  beauty  must  be 
truth/  the  expression  in  prose  of  his  ever  memor- 
able lines : — 

*  Beauty  is  truth,  truth  beauty, — that  is  all 
Ye  know  on  earth,  and  all  ye  need  to  know.'  ^^ 

The  critic  The  truth  is  no  event  in  Keats's  life  so  warmly 
and  the  poet,  commends  him  to  us,  or  shows  more  clearly  the 
robustness  of  his  mind,  than  his  attitude  in  this 
much  discussed  episode  {Endyntion).  In  the  first 
place,  he  had  a  clear,  for  so  young  a  man  an 
extraordinarily  clear,  perception  of  the  limitation  of 
his  own  powers  and  the  value  of  his  work.  The 
preface  to  Endyntion^  one  of  the  most  remarkable 
ever  written,  contains  his  own  lucid  judgement. 
He  felt  that  his  foundations  were  '  too  sandy,'  that 
the  poem  was  immature,  feverish  attempt,  in  which 
he  has  moved,  as  he  says,  from  the  leading-strings 
to  the  go-cart.  Did  any  critic  ever  sketch  with 
firmer  hand  the  mental  condition  of  a  young  man 
in  transition? 

*  The  imagination  of  a  boy  is  healthy,  and  the 
mature  imagination  of  a  man  is  healthy ;  but  the 
space  of  life  between,  in  which  the  soul  is  in  a  fer- 
ment, the  character  undecided,  the  way  of  life 
uncertain,  the  ambition  thick-sighted ;  thence  pro- 
ceeds mawkishness,  and  all  the  thousand  bitters 
which  those  men  I  speak  of  must  necessarily  taste 
in  going  over  the  following  pages.'  '^ 

A  long  But  as  I  speak,  from  out  the  memory  of  the  past 

ffToun^^        there  rises  before  me  a  shadowy  group,  a  long  line 


VARIA  269 

of  Students  whom  I  have  taught  and  loved,  and 
who  have  died  prematurely — mentally,  morally,  or 
bodily.     To  the  successful  we  are  all  willing  and 
anxious  to  bring  the  tribute  of  praise,  but  none 
so  poor  to  give  recognition  to  the  failures.     From 
one  cause  or  another,  perhaps  because,  when  not 
absorbed  in  the  present,  my  thoughts  are  chiefly 
in  the  past,  I  have  cherished  the  memory  of  many 
young  men  whom  I  have  loved  and  lost.    lo  victis  / 
let  us  sometimes  sing  of  the  vanquished  !     Let  us  Those  who 
sometimes  think  of  those  who  have  fallen  in  the  f^Y^  ^^^^ 
battle  of  life,  who  have  striven  and  failed,  who  have  of  life, 
failed  even  without  the  strife.     How  many  have 
I   lost   from   the  student  band  by  mental  death, 
and   from   so  many  causes — some  stillborn  from 
college,  others  dead  within  the  first  year  of  infantile 
marasmus,  while  mental  rickets,  teething,  tabes,  and 
fits  have  carried  off  many  of  the  most  promising 
minds.     From  improper  feeding  within  the  first  five  The  mental 
fateful  years  scurvy  and  rickets  head  the  mental  mor-  ^^^^ 
tality  bills  of  students.    To  the  teacher-nurse  it  is  a 
sore  disappointment  to  find  at  the  end  of  ten  years 
so  few  minds  with  the  full  stature,  of  which  the 
early  days  gave  promise.     Still,    so   widespread 
is  mental  death  that  we  scarcely  comment  upon 
it  in  our  friends.     The  real  tragedy  is  the  moral  The  moral 
death  which,  in  different  forms,  overtakes  so  many  ^^^^ 
good  fellows,  who  fall  away  from  the  pure,  honour- 
able, and  righteous  service  of  Minerva  into  the 
idolatry  of  Bacchus,  of  Venus,  or  of  Circe.    Against 
the  background  of  the  past  these  tragedies  stand 
out,  lurid  and  dark,  and  as  the  names  and  faces 


of  unfulfilled 
renown. 


270  VARIA 

of  my  old  boys  recur  (some  of  them  my  special 
pride),  I  shudder  to  think  of  the  blighted  hopes 
and  wrecked  lives,  and  I  force  my  memory  back 
to  those  happy  days  when  they  were  as  you  are 
now,  joyous  and  free  from  care,  and  I  think  of 
them  on  the  benches,  in  the  laboratories,  and  in 
the  wards — and  there  I  leave  them.  "^^ 

'Inheritors  Less  painful  to  dwell  upon,  though  associated  with 
a  more  poignant  grief,  is  the  fate  of  those  whom 
physical  death  has  snatched  away  in  the  bud  or 
blossom  of  the  student  life.  These  are  among  the 
tender  memories  of  the  teacher's  life,  of  which  he 
does  not  often  care  to  speak,  feeling  with  Long- 
fellow that  the  surest  pledge  of  their  remembrance 
is  '  the  silent  homage  of  thoughts  unspoken.'  As 
I  look  back  it  seems  now  as  if  the  best  of  us  had 
died,  that  the  brightest  and  the  keenest  had  been 
taken,  and  the  more  commonplace  among  us  had 
been  spared.  An  old  mother,  a  devoted  sister, 
a  loving  brother,  in  some  cases  a  broken-hearted 
wife,  still  pay  the  tribute  of  tears  for  the  untimely 
ending  of  their  high  hopes,  and  in  loving  remem- 
brance I  would  mingle  mine  with  theirs.  What 
a  loss  to  our  profession  have  been  the  deaths  of 
such  true  disciples  as  Zimmerman,  of  Toronto  ;  of 
Jack  Cline  and  of  R.  L.  MacDonnell,  of  Montreal ; 
of  Fred  Packard  and  of  Kirkbride,  of  Philadelphia ; 
of  Livingood,  of  Lazear,  of  Oppenheimer,  and  of 
Oechsner,  in  Baltimore — cut  off  with  their  leaves 
still  in  the  green,  to  the  inconsolable  gjief  of  their 
friends ! 


INDEX 


Agnostic,  visions  of  an,  102. 
Alcohol,  263. 

Ambition,  the  highest,  181. 
American  medicine,  22. 

—  peripatetic  teacher,  the  early, 
48. 

Andral  and  Louis  compared,  1 36. 
Anglo-Saxon,  the  practical,  65, 

66. 
Apathy,    the    physician's    most 

dangerous  foe,  204. 
Arnold,  Matthew,  the  death  he 

wished  for,  249. 
Art  of  detachment,  the,  85,  87. 

—  of  giving,  1 24. 
Authority,  vice  of,  14. 
Autopsies,  value  of,  178. 
Avocation,  ad  visability  of  having, 

178. 

Battle  of  life,  those  who  have 

fallen  in  the,  269. 
Beaumont,  William,  53  ;  the  man 

and  his  opportunity,  4. 
Beauty  is  truth,  267. 
Bell,  John,  1 79, 
Bichat,  55. 

Biology  and  the  humanities,  58. 
Books,   160;   value  of,  159;  by 

themselves  not  enough,  161. 
Borderland  pharmaceutical 

houses — the  practitioner's  foes, 

194. 
Bovell,  James,  45. 
Brain-dusting,  quinquennial,  an 

essential,  180. 
Breeding  and  pasture,  58. 
Broussais,  21. 
Browne,  Sir  William,  his  pocket 

library,  159. 


Callousness,  value  of,  95. 

Catholicity,  164. 

Charcot,  J.  M.,  a  cosmopolitan, 

16  ;  his  attractive  personality, 

1 7  ;  a  teacher  without  attempt 
at  display  or  effort,  1 7  ;  his 
method  a  clinical  lecture  with- 
out volubility,  17. 

Charity,  116,  120;  of  the  hos- 
pital, 123  ;  the  art  of  giving, 
124. 

Charlatanism,  85. 

Chauvinism,  70 ;  collegiate,  and 
dangers  of  in-breeding,  155;  in 
the  practitioner,  207. 

Cheek,  134. 

Clergy,  the,  and  physic,  193. 

Clinical  experiments,  28. 

Collegiate  chauvinism,  and 
dangers  of  in-breeding,  155. 

Common  sense,  256. 

Concentration,  and  thorough- 
ness,    132;     its     drawbacks, 

133- 

Conservatism  and  old  fogeyism, 
240. 

Consultant,  the,  212  ;  the  second 
period,  212  ;  his  brain  is  his 
capital,  212 ;  and  the  con- 
sultation, 213  ;  his  function, 
213;  the  unpleasant  features, 
214;  note-taking  and  time 
required,  215;  value  of  steno- 
graphy, 217  ;  his  opportuni- 
ties in  smaller  towns,  217. 

Credo  of  a  physician,  78. 

Critic  and  the  poet,  the,  268. 

Cui  bono?  67. 

Culture,  59. 

Curse  of  nationalism,  71. 


272 


INDEX 


Darwin,  Charles,  and  J.  Leidy, 
parallel  between,  47  ;  '  stretch- 
ing the  pia  mater^  48. 

Death,  pathos  of  early,  248 ; 
sudden,  248 ;  Matthew  Ar- 
nold's wish,  249  ;  the  physi- 
cian and  the  problem,  249  ; 
*  clean  forgotten,  like  the  dead 
man  out  of  mind,'  250  ;  com- 
munion of  saints  and  the  busy 
life,  250  ;  how  man  dies,  251 ; 
parting,  256;  a  long  shadowy 
group,  268 ;  those  who  have 
fallen  in  the  battle  of  life,  269  ; 
the  mental,  269;  the  moral, 
269. 

Debt  to  our  times,  100. 

Defeat,  no. 

Delian  sacrifice,  a,  260. 

Delilah  of  the  press,  256. 

Democracy,  tyranny  of,  24;  in 
medicine,  72. 

Detachment,  art  of,  85,  87  ;  in- 
tellectual, 86. 

Devotion,  and  heroism,  no;  to 
duty,  III. 

Diagnosis,  not  drugging,  190. 

Dilettante,  the,  133. 

Disaster,  should  be  faced  boldly, 
no. 

Discipline  of  science,  80. 

Disease,  nature  and,  78. 

Doctor  and  nurse,  always  with 
ns,  261. 

Doctors,  quarrels  of,  1 14 ;  friend- 
ly intercourse  needed,  115; 
training  an  important  factor, 
115;  mutual  concessions 
necessary,  117;  attitude  of 
mind  the  all-essential  to  pro- 
motion of  concord,  117;  say 
a  good  word  for  the  '  off 
colour'  man,  118;  tittle-tattle, 
121  ;  the  wagging  tongues, 
122. 

Dover,  Thomas,  a  good  fighter 
and  a  good  hater,  37 ;  dis- 
coverer of  Robinson  Crusoe, 
38  ;  '  Dover's  Powder,'  38. 

Dreamer,  the,  257. 


Dreams,  124. 

Drugs,   the  most  uncertain  ele- 
ment in  our  art,  116. 
Duty,  devotion  to,  iii. 

Education,  medical,  what  it  is, 
128  ;  its  aims  and  objects, 
128  ;  a  life  course,  142  ;  prac- 
tical, 151.  See  also  Medical 
art. 

Equanimity,  256. 

Eryximachus,  24. 

Evolution,  24. 

Examinations,  stumbling-blocks 
and  rocks  of  offence,  145. 

Experience,  152,  207  ;  and  the 
general  practioner,  202. 

Experiments  in  the  laboratory, 
27  ;  clinical,  28. 

Failure,  95. 

Faith,  science  and,  248. 

Fate,  the  practitioner's,  210. 

Fevers,  differentiation  of,  23. 

Foreign  travel,  169. 

France,  honours  her  great  men, 

17- 
French  school  in  the  'thirties,' 
a   medical    student's   day  at, 

137- 
Future,  the,  schemes  for,  256. 

Gehazis,  the,  107. 

General  practitioner,  the,  1 98 ; 
the  best  product  of  our  pro- 
fession, 1 98  ;  experience  and 
the,  203  ;  qualities  of  the,  208, 
See  also  Practitioner. 

Goldsmith,  Oliver,  compared 
with  O.  W.  Holmes,  39. 

Gospel  of  living,  the,  257. 

Great  men,  loo. 

Greeks,  back  to  the,  26. 

Gynaecologist,  the,  185. 

Harvey,  31. 

Heart,  incorruptible  treasures  of 
the,  59;  the  honest,  120.         ' 
Heroism  and  devotion,  no. 
Historical  study,  value  of,  I  a. 


INDEX 


273 


Holmes,  Oliver  Wendell,  38 ; 
his  '  one-hoss  shay,'  38  ;  the 
American  Goldsmith,  com- 
pared with  the  English  Gold- 
smith, 39 ;  compared  with 
Charles  Lamb,  39 ;  studied 
puerperal  fever,  39 ;  his  great 
contribution  to  science,  40 ; 
an  historic  paragraph  quoted, 
41  ;  his  conclusion  that  puer- 
peral fever  is  not  a  misfortune 
but  a  crime,  41 ;  essay  on 
Puerperal  Fever  and  the  Cham- 
bered IJauiilus,  42. 

Homoeopathy,  116. 

Honest  heart,  the,  120. 

Hospital,  charity  of  the,  123; 
students  in,  152.  See  also 
Medical  art,  teaching  the. 

Howard,  Palmer,  an  ideal  stu- 
dent-teacher, 44 ;  alert  to  new 
problems,  45. 

Humanities,  biology  and  the,  58. 

Humbug,  80. 

Humility,  81,  82  ;  reverence  for 
truth  the  fruit  of,  82. 

Humour,  sense  of,  an  essential, 
112. 

Hunter,  John,  31. 

Hutchinson,  Jonathan,  3. 

Ideals,  value  of,  105 ;  and  me- 
thods, 107. 

Ignorance,  one  of  the  physician's 
great  foes,  203 ;  and  Neglect, 
lives  offered  on  the  altar  of, 
260. 

Immortality,  of  the  flesh,  252  ; 
value  of  a  belief  in,  253  ;  con- 
fessio  fidei,  254. 

Immutability,  man's,  192. 

Imperturbability,  94 ;  often  mis- 
taken for  hardness,  95. 

In-breeding,  in  the  University, 
155;  dangers  of,  and  col- 
legiate chauvinism,  155. 

Incorruptible  treasures  of  the 
heart,  69- 

Independence,  practitioner's 

mental,  206. 


Index  Catalogue,  the,  158,  177. 
Infantilism  in  the  teacher,  165. 
'  Inheritors    of    unfulfilled    re- 
nown,' 270. 
Insanity,  261. 

Inscrutable  face,  value  of  an,  96. 
Intellectual  detachment,  86. 
Intemperance,  262. 
Isolation,  133. 

Johns  Hopkins  Hospital,  in- 
struction in  the  medical  art  its 
greatest  work,  150. 

Keats,  John,  his  master  passion, 

267. 
Killing  routine,  139. 
Knowledge,  sense  and  wisdom 

contrasted  with,  175. 

Laboratory,  experiments  in  the, 
27;  'the  lock  and  key,'  73; 
the  home,  192. 

La  crise  de  quarante  ans,  242. 

Laennec,  28. 

Lamb,  Charles,  compared  with 
O.  W.  Holmes,  39. 

Laws  of  nature  must  be  dis- 
covered, not  invented,  136. 

Leaven  of  life,  the,  61. 

Leidy,  Joseph,  his  patient  spirit, 
kindly  disposition,  and  sus- 
tained zeal,  47  ;  his '  ataraxia,' 
47  ;  parallel  between  him  and 
Darwin,  47  ;  '  stretching  the 
pia  mater ^  48. 

Lessons  of  life,  the  threegreat,  103. 

Library,  value  of  the  local,  158; 
Index  Catalogue,  158,  177; 
instructors,  159;  the  work- 
ing, 177. 

Life,  leaven  of,  61  ;  the  busy, 
useful,  and  happy,  100 ; 
poetry  of,  should  be  recog- 
nized in  the  humdrum  routine, 
III;  the  danger  of  the  busy, 
196;  the  strenuous,  nemesis 
in,  234  ;  philosophy  of,  236 ; 
the  calm,  contemplative,  245 ; 
two  views  in,  256. 


274 


INDEX 


Linacre,  4,  22. 

'  Lock  and  key '  laboratory,  the, 

73. 

Locke,  John,  character  of,  2 ; 
his  inflaence,  2. 

Loneliness,  persistency  in  the 
midst  of,  no. 

Lonely  road,  the,  209. 

Louis,  31  ;  practised  in  Odessa 
for  four  years,  32  ;  returned  to 
hospitals  for  six  years  for 
clinical  study,  32  ;  his  minute- 
ness of  inquiry  and  accuracy 
of  description,  33 ;  his  method 
spoken  of  with  contempt,  33  ; 
but  later  applauded  and  imi- 
tated, 34;  introduced  the 
Numerical  Method,  34;  by 
which  is  obtained  facts  upon 
which  the  edifice  of  medicine 
must  rest,  34  ;  his  channels  of 
influence,  35 ;  his  teaching  and 
influence,  35  ;  his  American 
pupils  in  Paris  between  1830 
and  1840,  39 ;  his  influence 
through  his  pupils,  91  ;  com- 
pared with  i^dral,  136. 

Love,  the  spirit  of,  123. 

MacDonnell,  Richard  Lea,  44. 

Man,  the  measure  of  the  school, 
141 ;  the  self-satisfied,  162  ; 
immutability  of,  192  ;  muta- 
bility of,  192 ;  a  medicine- 
taking  animal,  193  ;  mind  the 
measure  of,  258. 

Marriage,  220 ;  hopeless  passion, 
220  ;  emotions  on  ice,  220; 
the  two  goddesses,  221. 

Masters  in  medicine,  90 

Medical  art,  the,  is  world-wide, 
142  ;  teaching  the,  145  ;  study 
of  the,  148;  some  of  the  diffi- 
culties of,  148 ;  in  practice  a 
theoretical  training  alone  is 
inadequate,  149;  instruction 
in,  the  greatest  work  of  the 
Johns  Hopkins  Hospital,  150; 
necessity  of  practical  experi- 
ence, 152  ;   difficulty  of  judg- 


ing cases,  152 ;  probability 
the  guide  of  life,  153  ;  limita- 
tions of,  260. 

Medical  education.  See  Educa- 
tion. 

Medical  Society,  the,  161 ;  is  the 
safeguard  against  baneful  in- 
dividualism, 161. 

Medicine,  American,  2  2 ;  back 
to  the  Greeks,  26;  in  America, 
reform  in,  28 ;  in  America  at 
opening  of  nineteenth  century, 
30;  democracy  in,  72;  masters 
in,  90 ;  uncertainties  of,  153  ; 
history  of,  177;  new  school 
of,  190. 

Methods  and  ideals,  107. 

Microscope,  invention  of,  29. 

Mind,  nickel-in-the-slot  attitude 
of,i5o;  the  measure  of  man,258. 

Mind- training,  132. 

Missionary  work,  89 ;  as  willing 
to  teach  as  to  be  taught,  90. 

Mitchell,  Weir,  14, 

Morton,  Richard,  20. 

Mutability,  man's,  192. 

Narrow  spirit,  the,  167. 

Nationalism,  the  curse  of,  71. 

Nature,  and  disease,  78 ;  a, 
'  sloping  towards  the  southern 
side,*  112;  laws  of,  must  be 
discovered,  not  invented,  136 ; 
inexorable,  259;  cares  for  the 
species  while  the  physician 
cares  for  the  individual,  259. 

Nature-physicians,  the,  20. 

Nautilus,  the  Chambered,  O.  W. 
Holmes's,  42. 

New  school,  the,  67. 

New  student,  the,  49. 

Nineteenth  century,  53 ;  its  gift 
to  mankind,  1 3 ;  medicine  in 
America  at  opening  of,  30. 

Nurse,  the,  1 24 ;  the  discreet,  94  ; 
Romola  the,  1 24 ;  and  doctor, 
always  vrith  us,  261. 

Out-patient  department,  work  in, 
227. 


INDEX 


275 


Pain,  67. 

Past,  the,  24. 

Patience,  no. 

Pepper,  William,  a  strong  soul, 
7 ;  a  leader,  8  ;  a  child  of 
fortune,  8 ;  a  modern  Greek, 
9  ;  a  cultured  Hellene,  18 ;  an 
organizer,  19 ;  undiminished 
activity  to  the  last,  19. 

Perfection,  artistic  sense  of,  77. 

Peripatetic  life,  advantages  of, 
for  the  teacher,  167. 

—  teacher,  the  early  American, 
48. 

Persistency  in  the  midst  of  loneli- 
ness, no. 

Physic,  the  clergy  and,  193. 

Physician,  the,  qualities  of,  64  ; 
the  high  mission  of,  66 ;  cos- 
mopolitan character  of,  73 ; 
credo  of  a,  78  ;  the  true,  171  ; 
three  periods  of  his  life, 
173;  and  the  problem  of  death, 
249.     See  also  Practitioner. 

Physicians,  two  sorts  of,  171  ; 
verse- writing,  266. 

Pills  and  potions,  88,  193. 

Pioneer  spirit,  the,  52. 

Pluralist,  the,  182. 

Poet,  the  critic  and  the,  268. 

Poet's  gift,  the,  265. 

Poetry,  a  divine  madness,  265. 

—  of  life,  should  be  recognized 
in  the  -humdrum  routine,  in. 

Potions,  pills  and,  88,  193. 

Practical  education,  151. 

Practice,  and  science,  74  ;  isola- 
tion of,  208. 

Practitioner,  the,  dead  mentally 
in  ten  years  without  study, 
174;  simply  seeing  not  all, 
175;  value  of  note-taking, 
175;  habits  of  routine  and 
system,  176;  must  play  the 
game  fair,  1 76 ;  only  way  to 
make  real  progress,  1 76 ;  the 
desiderata  of  every  young 
doctor,  177  ;  his  working 
library,  177  ;  should  have  an 
avocation,    178;    should    be 


careful  in  his  publication,  178  ; 
his  studiousness  may  be  a 
stumbling-block,  1 79 ;  student 
habits  in  a  large  city,  1 79 ; 
his  difficulties,  and  how  he 
may  overcome  them,  1 79 ; 
quinquennial  brain-dusting  es- 
sential, 180 ;  end  of  the  second 
lustrum,  1 80  ;  the  highest  am- 
bition— the  cultivated  general 
practitioner,  181 ;  observation 
of  facts,  191 ;  the  home  labora- 
tory, 192  ;  his  foes — the  bor- 
derland pharmaceutical  houses, 
194  ;  danger  of  the  busy  life, 
196 ;  the  busy  doctor,  196 ;  the 
general  practitioner,  198;  the 
general  practitioner  the  best 
product  of  our  profession,  198; 
dangers  of  prosperity,  198 ; 
politics,  198  ;  opening  a  sana- 
torium, 199;  moving  to  a 
larger  place,  199 ;  the  rou- 
tinist,  199 ;  the  rationalist, 
201 ;  corroding  effect  of  rou- 
tine, 202  ;  experience  and  the 
general  practitioner,  202  ;  the 
man  who  does  not  read,  202  ; 
his  three  great  foes — ignor- 
ance, apathy,  and  vice,  203 ; 
the  spirit  of  humility,  con- 
fidence, just  pride,  and  hope, 
206  ;  his  mental  independence, 
206 ;  self-satisfaction,  206 ; 
experience,  207 ;  chauvinism 
in  the,  207 ;  qualities  of  the, 
208;  isolation  of  practice,  208; 
the  lonely  road,  209;  words 
to  soothe  the  heartache,  209 ; 
his  fate,  210;  success,  211. 
See  also  General  Practitioner 
and  Physician. 

Presenility,  243. 

Press,  Delilah  of  the,  356. 

Probability,  153. 

Profession,  the,  what  it  is,  1 29. 

Professional  sensitiveness,  84. 

Professor,  the,  154. 

Progeria  in  the  teacher,  165. 

Pseudo-science,  195. 


276 


INDEX 


Public,  the  credulous,  358. 

Publication,  178. 

Puerperal  fever,  studied  by 
O.  W.  Holmes,  39 ;  Holmes's 
conclusion  that  its  existence  is 
not  a  misfortune  but  a  crime, 
41 ;  essay  on,  by  Holmes,  42. 

Rationalist,  the,  201. 
Readers,  four  sorts  of,  160. 
Reaper,  the,  often  not  the  sower, 

158. 
Reform  in  medicine  in  America, 

38. 
Registration,  interprovincial  and 

international,  25. 
Responsibility  and    proportion, 

sense  of,  140, 
Romola  the  nurse,  124. 
Routine,   and  system,  habit  of, 

176;    the  only  way  to  make 

real  progress,  1 76 ;  corroding 

effect  of,  302  ;  value  of,  331. 
Routinist,  the,  199, 

Scepticism,  value  of,  139. 

School,  true  greatness  of  a,  140; 
man  the  measure  of  the,  141. 

Science,  the  last  and  chief  bless- 
ing) 1 3 ;  Slid  practice,  74 ; 
discipline  of,  80  ;  and  faith, 
248  ;  and  the  spirits,  251. 

Sciences,  the,  essential,  81. 

Scientific  men,  value  of,  141. 

Self-satisfied  man,  the,  162. 

Sense  ofhumour,  an  essential,  112. 

Sensitiveness,  professional,  84. 

Silent  workers,  the,  96. 

Specialism,  181, 183;  advantages 
of,  183;  the  public  and,  184; 
dangers  of,  186. 

Specialist,  the,  182  ;  dangers  of 
adopting  a  speciality  too  early, 
182;  his  dangers,  186;  how 
he  may  avoid  them,  186 ;  nar- 
row and  pedantic  specialists, 
187 ;  advantages  of  study  of 
physiology  and  pathology  to, 
187  ;  education  and  the,  188  ; 
societies  and  the,  189. 


Spirit  of  love,  the,  123. 

Stenography,  value  of,  217, 

Student,  the,  130;  how  you  may 
know  him,  131;  two  types  of, 
131  ;  habits  of  concentration 
and  thoroughness,  132 ;  the 
dilettante,  133;  his  isolation, 
133;  drawbacks  of  concentra- 
tion, 133;  should  get  dena- 
tionalized early,  133;  the  self- 
conscious,  134;  should  study 
men,  134;  distinction  between 
self-confidence  and  '  cheek," 
134;  the  waiting  years,  135; 
thorough  regard  for  truth  and 
elevation  of  mind  essentials  to 
the  accurate  observer  of  dis- 
ease, 1 36 ;  a  day  at  the  French 
school  in  the  'thirties,'  137; 
the  delights  of  acquiring  posi- 
tive information  and  method 
of  obtaining,  137;  relation  of 
teacher  to,  138  ;  his  sense  of 
responsibility  and  proportion, 
140;  his  education  a  life 
course,  142  ;  the  genius,  142  ; 
examinations,  145  ;  the  nickel- 
in-the-slot  attitude  of  mind, 
150;  the  ward  as  a  class-room, 
151  ;  work  in  the  hospital, 
153.  See  also  Medical  art, 
teaching  the. 

Student  life,  the,  104. 

Studiousness,  m  ay  be  a  stumbling- 
block,  179. 

Study,  method  of,  131  ;  the  time 
for,  131. 

Study  men,  134,  179. 

Style  in  writing,  264. 

Success,  211. 

Sydenham,  4,  31;  scepticism 
of,  4. 

Teacher,  relation  of,  to  student, 
138 ;  the  good,  142 ;  in- 
fantilism in  the,  165  ;  progeria 
in  the,  165  ;  advantages  of 
the  peripatetic  life  forthe,  167; 
the  fossilized,  240. 

Teachers,   and   teaching,    138 ; 


INDEX 


277 


fonr  classes  of,  1 39  ;  killing 
routine  saps  vitality  of,  139. 

Teacher's  life,  three  periods  in 
the,  243. 

Thinkers,  143. 

Thinking,  a  University  fanction, 
144. 

Thoroughness,  84. 

Three  great  lessons  of  life,  the, 
103. 

Time  is  money,  173. 

Times,  duty  to  better  onr,  51  ; 
our  debt  to,  100. 

Tittle-tattle,  121. 

Tongue,  the  careless,  94 ;  un- 
ruly member,  the,  94. 

Training,  an  important  factor, 
115. 

Travel,  164;  and  change,  168; 
foreign,  169. 

Truth,  fragments  of,  79  ;  hard 
to  reach,  80 ;  reverence  for, 
the  fruit  of  humility,  82 ; 
whatitis,  83;  not  recognizing 
it  is  mind-blindness,  83 ;  and 
elevation  of  mind,  thorough 
regard  for  essentials  to  the 
accurate  observer  of  disease, 
136. 


Uncertainties  of  medicine,  153. 

Uncharitableness,  the  most  per- 
nicious of  all  vices,  118;  a 
thoughtless  evil  at  times,  118  ; 
'  the  faint  praise  that  damns,' 
119. 

University,  function  of  to  think, 
144. 

—  in-breeding  in  the,  155. 

—  spirit,  the,  156. 

—  teaching  staff,  value  of 
changes  in,  154. 

Unruly  member,  the,  94. 
Utility  cry,  the,  103. 


Vaso-motor  control,  95. 
Verse-writing  physicians,  366. 
Vice,  of  authority,  14 ;    one  of 

the  physician's  great  foes,  205. 
Virchow,    Prof.,    visit    to,    6  ; 

the  citizen,  7 ;  the  sanitarian, 

54- 
Visions  of  an  Agnostic,  102. 
Voiceless,  the,  loi. 
Volte-face  often  necessary,  52. 

Wagging  tongues,  the,  122. 
Waiting  years,   the,   135,    172, 

173- 

Walk  with  the  young,  244. 

Wanderjahre,  need  of  the,  70. 

Ward,  the,  as  a  class-room,  151. 

West,  the,  the  future  with,  164. 

Wisdom,  66 ;  sense  and,  con- 
trasted with  knowledge,  1 75. 

Women,  old  and  new,  loi. 

Work,  the  master  word,  223  ; 
get  a  relish  for,  224  ;  haste 
not  to  be  encouraged,  224; 
ohne  Hast,  ohne  Rast,  224; 
live  for  the  day,  224;  the 
day's  work,  225;  influence  of 
isolation,  225 ;  industry  es- 
sential at  all  ages,  226 ;  the 
out-patient  department,  227; 
the  small  field,  227  ;  system  to 
be  cultivated,  227  ;  value  of 
routine,  231 ;  dangers  of  over- 
work, 231  ;  nemesis  in  the 
strenuous  life,  234;  need  of 
an  avocation,  235  ;  the  man, 
not  the  doctor,  236  ;  idleness, 
236 ;  failure,  237. 

Workers,  the  silent,  96. 

Working  library,  the,  177. 

Worry,  233. 

Writing,  style  in,  264. 

Young  doctor,  the  desiderata  of 
every,  177. 


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